0
Experience
Implementation of a pharmacist-run telephonic insulin titration service
Emily Weidman-Evans; Jeffery Evans; Robert Eastwood; Ashley Fort
J Am Pharm Assoc (2003) 2012;52:e266-e272. doi:10.1331/JAPhA.2012.11225

Abstract

Objectives  To describe an insulin titration-by-phone service conducted by pharmacists and to discuss the effects of this service on patient care and outcomes in the first year of its existence.

Setting  An academic family medicine department in which pharmacists practice in nondistributory roles, from March 2009 through March 2010.

Practice description  Pharmacy services within the department include a chronic disease medication therapy management clinic as well as consultation in various other primary care and specialty clinics. Fourth-year student pharmacists complete advanced pharmacy practice experiences at this site as well.

Practice innovation  Based upon a need identified by department providers (physicians and physician assistants), an insulin titration-by-phone service was implemented by two faculty pharmacists. Patients were referred into this service by their primary care provider (PCP) and were called by one of the pharmacists on a regular basis. Pharmacist recommendations for insulin dose adjustments were made based on patient reported self-monitored glucose values. PCP approved recommendations and the patient was notified of changes.

Main outcome measure  Decrease in glycosylated hemoglobin (A1C ) within 9 months of referral to the service when compared with baseline.

Results  Analysis included 76 patients. The mean decrease in A1C was 1.55% (SD 2.31; P <0.001). The largest decrease in A1C (1.4%) was seen in the first 3 months after referral. Seven patients achieved an A1C ≤7% ( P = 0.007). Forty-one patients had a decrease in A1C of at least 1% during the first 9 months after their referral ( P <0.001).

Conclusion  The implementation of a pharmacist-run insulin titration-by-phone service resulted in improvements in A1C that were most pronounced in the first 3 months after referral.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.

OR

Register for a FREE limited account to benefit from personalization features such as alerts.

References

Selvin E, Marinopoulos S, Berdenblit G, et al.  Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus.  Ann Intern Med.  2004; 141: 421– 31. [PubMed]
 
The Action to Control Cardiovascular Risk in Diabetes Study Group.  Effects of intensive glucose lowering in type 2 diabetes.  N Engl J Med.  2008; 358: 2545– 59. [PubMed]
 
ADVANCE Collaborative Group.  Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.  N Engl J Med.  2008; 358: 2560– 72. [PubMed]
 
Duckworth W, Abraira C, Moritz T, et al.  Glucose control and vascular complications in American veterans with type 2 diabetes.  N Engl J Med.  2009; 361: 1024– 5. [PubMed]
 
American Diabetes Association.  Standards of medical care in diabetes: 2010.  Diabetes Care.  2010; 33( suppl S1): S11– 61. [PubMed]
 
Kennedy L, Herman WH, Strange P, et al.  Impact of active versus usual algorithmic titration of basal insulin and points-of-care versus laboratory measurement of HbA1C on glycemic control in patients with type 2 diabetes.  Diabetes Care.  2006; 29: 1– 8. [PubMed]
 
Blonde L. Merilainen M, Darwe V, Raskin P; TITRATE Study Group.  Patient-directed titration for achieving glycaemic goals using a once-daily basal insulin analogue: an assessment of two different fasting plasma glucose targets—the TITRATE Study.  Diabetes Obes Metab.  2009; 11: 623– 31. [PubMed]
 
Polonsky WH, Fisher L, Guzman S, et al.  Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem.  Diabetes Care.  2005; 28: 2543– 5. [PubMed]
 
Swinnen SGHA, DeVries JH.  Contact frequency determines outcome of basal insulin initiation trials in type 2 diabetes.  Diabetologia.  2009; 52: 2324– 7. [PubMed]
 
Wubben DP, Vivian EM.  Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review.  Pharmacotherapy.  2008; 28: 421– 36. [PubMed]
 
Nkansah NT, Brewer JM, Connors R, Shermock KM.  Clinical outcomes of patients with diabetes mellitus receiving medication management by pharmacists in an urban private physician practice.  Am J Health Syst Pharm.  2008; 65: 145– 9.
 
McCord AD.  Clinical impact of a pharmacist-managed diabetes mellitus drug therapy management service.  Pharmacotherapy.  2006; 26: 248– 53. [PubMed]
 
Kiel PJ, McCord AD.  Pharmacist impact on clinical outcomes in a diabetes disease management program via collaborative practice.  Ann Pharmacother.  2005; 39: 1828– 32. [PubMed]
 
Rosenstock J, Davies M, Home PD, et al.  A randomized, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naïve people with type 2 diabetes.  Diabetologia.  2008; 51: 408– 16. [PubMed]
 
Fogelfeld L, Dharmalingam M, Robling K, et al.  A randomized, treat-to-target trial comparing insulin lispro protamine suspension and insulin detemir in insulin-naïve patients with type 2 diabetes.  Diabet Med.  2010; 27: 181– 8. [PubMed]
 
Rochester CD, Leon N, Dombrowski R, Haines ST.  Collaborative drug therapy management for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus.  Am J Health Syst Pharm.  2010; 67: 42– 8. [PubMed]
 
Coast-Senior EA, Kroner BA, Kelley CL, Trilli LE.  Management of patients with type 2 diabetes by pharmacists in primary care clinics.  Ann Pharmacother.  1998; 32: 636– 41. [PubMed]
 
Ragucci KR, Fermo JD, Wessell AM, Chumney EC.  Effectiveness of pharmacist-administered diabetes mellitus education and management services.  Pharmacotherapy.  2005; 25: 1809– 16. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
PubMed Articles
Advertisement
 
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints