Improved Glycemic Control With Minimal Change in Medication Regimen Complexity in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic

• Published in: The Annals of pharmacotherapy 2018-11, Vol.52 (11), p.1091-1097
• Main Authors: Morello, Candis M., Rotunno, Taylor, Khoan, John, Hirsch, Jan D.
• Format: Article
• Language: English
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1177/1060028018776663

Background: Gaining glycemic control in patients with type 2 diabetes (T2D) usually requires more complicated medication regimens. Increased medication regimen complexity (MRC) negatively impacts adherence and clinical outcomes. Objective: Compare MRC change in patients with uncontrolled T2D referred to a collaborative pharmacist-endocrinologist Diabetes Intense Medical Management (DIMM) clinic “tune up” model versus similar patients receiving usual primary care provider (PCP) care over 6 months. Methods: Retrospective, observational, comparative cohort study compared MRC of complex DIMM clinic patients to a similar group (adults with T2D, glycosylated hemoglobin [A1C] ≥8%), continuing to receive usual care from their PCPs. The MRC Index (MRCI) was used to quantify MRC. Results: Both DIMM (n=99) and PCP (n=56) groups were similar, with high baseline mean MRC scores as measured by number of medications and MRCI (12.0 [SD=5.7] vs 13.7 [SD = 5.6], and 32.7 [SD=17.0] vs 38 [SD=16.5]), respectively. Mean MRC change over 6 months was not significantly different between groups, although mean A1C reduction was significantly greater in the DIMM versus PCP group (−2.4% [SD=2.1] vs −0.8% [SD=1.7], P