2240-PUB: Predictability of HbA1c Control Based on Pharmacotherapy Regimen or the Number of Diabetes-Related Touches in a Rural Population

Given the explosion of pharmacologic agents indicated for patients diagnosed with type 2 diabetes, coupled with the decline in physicians practicing in rural settings, pharmacists are positioned to serve as extenders. In this resource-limited environment, assumptions are often applied to predict outcomes based on patient’s frequency of appointments or pharmacotherapy regimen. The goal of this study is to determine if select medications or the number of clinical touches support assumptions predicting a patient’s HbA1c control.

A single center retrospective chart review was conducted for patients with an ICD-10 code related to type 2 diabetes. Data extracted from the electronic medical record included demographics, HbA1c with trend, dates of diagnosis, pharmacotherapy regimen, and number of clinical diabetes related touches. Touches were defined as documentation of diabetes related management through office appointment or remote communication. This project was approved by the institutional quality improvement performance registry process. Fisher exact, Wilcoxon test, and descriptive statistics were used for analysis.

Sample data for 300 patients revealed baseline demographic information for study population’s average age of 64 years and 43% were female. The number of clinical touches on predicting HbA1c control was not found to be statistically significant (P = 0.1582). However, there was a significant association for select medications when evaluated in combination with frequency of clinical touches to predict control. Insulin was the only agent that when evaluated solely resulted in a significantly lower HbA1c (p=0.03).

Sample population data shows that increased touches did not predict improved HbA1c values, however it could be considered that less controlled HbA1c were being followed more frequently and thus altering outcomes. Additional evaluation is needed to more closely investigate the combination of agents.