2025 Southeastern Residency Conference

Title: Impact of Pharmacist Intervention on Optimizing Guideline Directed Medication Therapy Prescribing of GLP-1 Agonists and/or SGLT2 Inhibitors in High-Risk Patients with Diabetes


Authors: Holly Johnson, Min Chul Kim, Amanda Stankowitz, Alexander Tunnell, TiShay Perry


Objective: To determine if targeted pharmacist interventions could effectively address identified barriers and optimize the prescribing of GDMT in this patient population.


Self-assessment Question: True or False: Targeted pharmacist interventions optimized the prescribing of GDMT in this patient population.


Background: The 2024 American Diabetes Association guidelines recommend glucagon-like peptide-1 receptor agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) as first-line agents for adult type 2 diabetic patients at high-risk of or with a history of atherosclerotic cardiovascular disease (ASCVD). Per these guidelines, high-risk for ASCVD is defined as those with end organ damage or multiple cardiovascular risk factors. A medication use evaluation was conducted from January 1st, 2024 to March 31st, 2024 at WT Anderson Community Health Center (WTACHC) and revealed that only 45% of high-risk type two diabetic patients were prescribed recommended guideline directed medication therapy (GDMT) of either a GLP-1 agonist or SGLT2i. Potential barriers to prescribing were identified. The purpose of this study was to determine if targeted pharmacist interventions could effectively address identified barriers and optimize the prescribing of GDMT in this patient population.


Methodology: For this single-centered, IRB-approved, prospective comparative study investigators assessed all adult type two diabetic patients seen at the WTACHC for ASCVD risk status. The pre-intervention cohort included patients from January 1st, 2024 to March 31st, 2024, and the post-intervention cohort included patients from October 1st, 2024 to December 31st, 2024. A daily list of targeted pharmacist interventions to initiate a GLP-1RA or SGLT2i for eligible patients was then generated and presented to physicians for review. The primary outcome of this study was the rate of appropriately prescribed GDMT of either a GLP-1RA or SGLT2i following provider education and pharmacist intervention. Secondary outcomes included the percent of patients with a documentation for not receiving GDMT, percent of patients without documentation but with a presumed reason for not receiving GDMT, and percent of pharmacist interventions accepted. Statisical analysis included independent chi-square tests. 


Results: A total of 180 patients were included in the pre-intervention cohort and 266 in the post-intervention cohort. The primary outcome of the rate of appropriately prescribed GDMT in high-risk patients increased by 10% (95% CI, 0.59% to 19.41%, p=0.078), from 45% (95% CI, 37.7% to 52.3%) in the pre-intervention cohort to 55% (95% CI, 49% to 61%) in the post-intervention cohort. An 8% decrease was seen for the secondary outcome of patients with a documented reason for not receiving GDMT (95% CI, -3.84% to 19.84%, p=0.23), dropping from 34% (95% CI, 24.6% to 43.4%) in the pre-intervention cohort to 26% (95% CI, 18.7% to 33.3%) in the post-intervention cohort. However, there was a 1% increase in the percentage of patients without a documented reason but with a presumed appropriate reason for not receiving GDMT (95% CI -4.81% to 6.81%, p=0.96), increasing from 5% (95% CI, 0.7% to 9.3%) in the pre-intervention cohort to 6% (95% CI, 2.1% to 9.9%) in the post-intervention cohort. Overall, 142 targeted pharmacist interventions were made, with an acceptance rate of only 14%.


Conclusions: The rate of appropriately prescribed GDMT did increase in the post intervention cohort but was not determined to be a statistically significant difference. Additionally, the interventions did not result in a significant increase in the percentage of patients with a documented reason for not receiving GDMT. Despite the educational efforts, there was a decrease seen in documentation for this population. There was also no significant change in the percentage of patients without a documented reason but with a presumed appropriate reason for not receiving GDMT, and most pharmacist interventions were not accepted. The lack of statistically significant results in this study may be attributed to the interventions being conducted on paper rather than in face-to-face interactions. Future studies could consider more personalized, individualized interventions to improve outcomes for each patient.