Premium
Pharmacist intervention lowers HgbA1c in diabetic patients regardless of HIV status
Author(s) -
Nelson Noelle E.,
Hluhanich Rebecca M.,
Wilson Machelle,
Fine Jeffrey
Publication year - 2021
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/jppr.1722
Subject(s) - medicine , glycemic , type 2 diabetes , diabetes mellitus , cohort , body mass index , pharmacy , cohort study , family medicine , insulin , endocrinology
Background Despite the higher prevalence of type 2 diabetes mellitus (T2DM) co‐morbidity in patients with human immunodeficiency virus (HIV), little research has been done into the ability to meet glycemic targets in HIV‐positive patients versus HIV‐negative patients. More studies are needed to address whether the management of T2DM in patients with co‐morbid HIV is more complex in terms of reaching guideline‐directed glycemic target endpoints compared to the management of T2DM in patients without HIV. The purpose of this study was to evaluate the difference in glycemic control between HIV‐positive and HIV‐negative patients when managed by a clinical pharmacist in a federally qualified health center (FQHC). Aim The aim of this research was to compare glycaemic control in HIV‐positive patients on antiretroviral therapy to HIV‐negative patients following pharmacist interventions. Methods This retrospective observational cohort study conducted at a FQHC included adults with type II diabetes mellitus who attended at least two clinical pharmacy appointments between 1 January 2018 and 31 July 2019. Exclusion criteria included missing pre‐ or post‐haemoglobin A1c (HgbA1c) values, type 1 diabetes, pregnancy, breastfeeding, deceased, or untreated HIV. The primary endpoint was change in HgbA1c from baseline to month 3. Secondary endpoints were change in HgbA1c at 6, 9, and 12 months, and time to goal. Additional endpoints included changes in number of anti‐diabetic agents, blood pressure, body mass index, hypoglycaemic events, percent of patients on a sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitor or glucagon‐like peptide (GLP‐1) agonist. This study was exempt from the University of California, Davis Institutional Review Board as a continuous quality improvement study. Seventy‐eight patients were included, 17 of whom were HIV‐positive. Results At 3 months, HgbA1c was reduced by −1.7% and –1.2% ( P = 0.31) for HIV‐positive and ‐negative patients, respectively. In the pooled cohort, HgbA1c was reduced from baseline at all time points, and 24% of patients achieved HgbA1c below 7.0%. The number of antidiabetic medications remained unchanged or was decreased in 60% of patients. Conclusion The study demonstrated clinically important HgbA1c reductions without increasing the medication burden in most patients. There was no significant difference in glycaemic management between HIV‐positive and HIV‐negative patients.