Parkland Health and Hospital System (PHHS) is one of the largest safety net health systems in the United States serving the indigent population of Dallas County. The majority of patients with diabetes seen in the PHHS Primary Care clinics receive their medications through PHHS pharmacies which offer subsidized prices for medications on the PHHS formulary. The GLP-1 agonist, liraglutide, was added to the formulary at the end of 2016. To improve glycemic control in the primary care clinics, bi-monthly webinars providing diabetes education, in conjunction with e-consultations between primary care providers and diabetes specialists, were begun in early 2017 with an emphasis on using GLP-1 agonists. GLP-1 agonist prescriptions in the PHHS primary care clinics increased 435% (34 to 148) between 2016-2017 and 168% (148 to 248) from 2017-2018, an overall increase in prescribing of 729%. Of the 469 patients who were prescribed GLP-1 agonists from 2015-2018, 316 patients had baseline and post-prescription Hba1c values available. The average baseline Hba1c at time of prescription was 9.0% with an average final Hba1c value of 8.4% (p=0.0005). This data shows how an institutional formulary can be used as an agent of change to improve glycemic control. Of note, 90% of prescriptions were written for liraglutide with the other 10% including other GLP-1 agonists such as exenatide, albiglutide, and dulaglutide, showing the effect of diabetes education in prescribing practices.


U. Gunasekaran: None.

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