Pharmacists Make Strides in Improving Diabetes Care

Clinical pharmacist Candis Morello serves as the director of San Diego Department of Veterans Affairs (VA) Diabetes Intense Medical Management (DIMM) clinic. With her counseling, veterans with a history of type II diabetes are learning how to improve their condition.

The veterans who are clinic patients have dealt with diabetes for at least 10 years – many of them longer. They have glycosylated hemoglobin (hbA1c) levels higher than 8%, and suffer from additional ailments other than their diabetes.

Morello says she provides a “personalized tune-up” for all of the veterans with rather complex medical cases. Patients spend an hour with her during their first appointment. During this hour, she and the patient work together to develop attainable goals for both lifestyle and treatment, as well as motivational tactics to help the veterans reach those goals.

For most patients, the motivator is how many times they wake up at night to take a trip to the bathroom. Many of them say they wake up anywhere from five to eight times a night. When Morello tells them she can help them fix the problem with a few weeks, so they can see an increase in energy, they are more than willing to make the program work.

The clinic is only open four hours a week. The majority of patients need three to five appointments with Morello before they can return to their primary care physician for diabetes management.

Morello presented data at the American Diabetes Association San Francisco meeting in June. Her work showed that over the course of six months, the average hbA1c level fell 2.4% for the 85 patients of the DIMM clinic. Over the same period, 51 patients who were only seeing a primary care physician saw only a 0.2% decrease in their hbA1c level.

From a monetary standpoint, the program saves $6,412 per DIMM patient over a three year period. For every dollar spent on Morello’s services, there’s a $7.81 return on investment.

Because of the success of her program, Morello has shared information about how her program works with other VA staff members and outside groups. She hopes versions of her program will be implemented on a wider scale to help not just more veterans, but more diabetics in general.

A primary care provider in San Antonio, Texas is taking cues from the program. With the help of pharmacist Jodie Gee, 118 patients saw an average of a 4% decrease in hbA1c level, compared to diabetics who did not have a pharmacist as part of their diabetes management team.

Gee sees her patients monthly for 45 minutes. There’s a comprehensive review of medications, for diabetes and other health conditions. There’s also a review of glucose levels and diet. Newly diagnosed diabetics also receive information about how medications work and how important it is to follow doctor’s orders.

Ultimately, programs like the ones Morello and Gee are part of show that having a pharmacist as part of a primary care team is helpful to diabetics.