2025 Southeastern Residency Conference

Title: Diabetes Outcomes of Patients Followed by Embedded Pharmacists in Primary Care Clinics


Authors: Cassie Twisdale, Amy Robinson, Danielle Land, Alex Ewing 


Objective: Identify diabetes outcomes and early impacts of having embedded pharmacists in primary care clinics


Self Assessment Question: Which of the following were early impacts within 3-6 months of having pharmacists manage diabetes in primary care clinics?
A) Significant lowering of A1c
B) Close follow up with phone visits
C) Increased prescribing of GLP-1 agonists
D) All of the Above


Background: The American Diabetes Association supports the use of a collaborative, multidisciplinary team approach to improve patient care when managing diabetes. Pharmacists ensure patients are on optimal guideline directed medical therapy, provide patient education, and monitor with close follow-up to allow for quicker dose escalations. Prisma Health recently embedded clinical pharmacists into two additional primary care clinics. This study will assess the pharmacists’ impact on quality of care by comparing diabetes outcomes of patients managed by newly embedded clinical pharmacists to diabetes outcomes of patients managed exclusively by providers.  


Methods: A multicenter, observational, retrospective cohort study was conducted examining adults 18 years of age or older with a diagnosis of diabetes and a hemoglobin A1c (A1c) above 8%. Patients in the pharmacist intervention group were referred to the PharmD between December 2023 to March 2024 and were required to have at least two interactions with the pharmacists during the study period. Comparator clinics were two primary care clinics within the health system that did not have an embedded pharmacist but were of similar size and patient demographics to the investigated clinics. Patients meeting inclusion criteria from the comparator clinics were randomly selected for analysis using a random number generator. The primary outcome was the reduction in A1c from baseline to next A1c three to six months later. Secondary outcomes include percent of patients on a continuous glucose monitor (CGM), number of CGM touchpoints or interpretations, number of visits during study period, use of evidence-based therapies, emergency room or hospital admissions related to diabetes care, weight loss, and number of patients assisted with medication access issues.  


Results: A total of 98 patients were included in the IRB-approved study with 49 patients in the pharmacist intervention group and 49 patients in the comparator primary care provider group. Baseline characteristics were similar between groups. The pharmacist group had a change in A1c from 9.97% to 7.83% at 3-6 months while the provider group had change in A1c of 9.51% to 9.36% at 3-6 months. A significant difference was found with the pharmacist group lowering A1c by 2.14% compared to the provider group lowering by 0.15% (p<0.001). Secondary outcomes of phone encounters, medication adjustment, continuous glucose monitor use, and assistance with medication access were statistically significant (p<0.001 for all). Pharmacists also initiated more GLP-1 RAs compared to provider (20 additional patients vs 1 additional patient, p<0.001). In patients with cardiovascular disease, pharmacists also had significantly more patients on a GLP-1 RA compared to the provider group (68.42% vs 11.76%, p=0.002) No significant differences were found between groups with SGLT-2 inhibitor use, emergency room or hospital admissions related to diabetes care or weight loss.


Conclusion: Pharmacist management of type 2 diabetes significantly lower A1c.  Pharmacists were able to provide closer follow up and assist with more medication access and continuous glucose monitor assessment than primary care providers. The early impacts of pharmacist management of diabetes can help to provide additional justification of more pharmacists in the primary care setting. Additionally, the impacts of pharmacists on diabetes outcomes help to support an automatic referral to pharmacists for patients with uncontrolled diabetes.