1 Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, La Jolla, CA, USA.
2 Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.
Ann Pharmacother. 2018 Nov;52(11):1091-1097. doi: 10.1177/1060028018776663. Epub 2018 May 18.
Gaining glycemic control in patients with type 2 diabetes (T2D) usually requires more complicated medication regimens. Increased medication regimen complexity (MRC) negatively impacts adherence and clinical outcomes.
Compare MRC change in patients with uncontrolled T2D referred to a collaborative pharmacist-endocrinologist Diabetes Intense Medical Management (DIMM) clinic "tune up" model versus similar patients receiving usual primary care provider (PCP) care over 6 months.
Retrospective, observational, comparative cohort study compared MRC of complex DIMM clinic patients to a similar group (adults with T2D, glycosylated hemoglobin [A1C] ≥8%), continuing to receive usual care from their PCPs. The MRC Index (MRCI) was used to quantify MRC.
Both DIMM (n=99) and PCP (n=56) groups were similar, with high baseline mean MRC scores as measured by number of medications and MRCI (12.0 [SD=5.7] vs 13.7 [SD = 5.6], and 32.7 [SD=17.0] vs 38 [SD=16.5]), respectively. Mean MRC change over 6 months was not significantly different between groups, although mean A1C reduction was significantly greater in the DIMM versus PCP group (-2.4% [SD=2.1] vs -0.8% [SD=1.7], P<0.001, respectively).
Outcomes represent the first report demonstrating how treating patients with an innovative DIMM model can help complex T2D patients achieve glycemic control without increasing the MRC to more than a comparator group. With the growing prevalence of T2D and associated elevated treatment costs, identifying effective means for achieving glycemic control without increasing complexity is needed. Application of this model may be considered by other health systems to aid in achieving outcome measures.
2 型糖尿病（T2D）患者获得血糖控制通常需要更复杂的药物治疗方案。增加药物治疗方案的复杂性（MRC）会对依从性和临床结果产生负面影响。
比较在接受协作药剂师-内分泌学家糖尿病强化医疗管理（DIMM）诊所“调整”模式治疗的血糖控制不佳的 T2D 患者与接受常规初级保健提供者（PCP）护理的类似患者在 6 个月期间 MRC 的变化。
回顾性、观察性、比较队列研究比较了复杂 DIMM 诊所患者的 MRC 与类似的组（糖化血红蛋白[HbA1C]≥8%的 T2D 成年人），他们继续接受他们的 PCP 的常规护理。使用 MRC 指数（MRCI）来量化 MRC。
DIMM（n=99）和 PCP（n=56）组均相似，药物数量和 MRCI 的基线平均 MRC 评分较高（分别为 12.0[SD=5.7]和 13.7[SD=5.6]，32.7[SD=17.0]和 38[SD=16.5]）。6 个月期间两组的 MRC 变化无显著差异，但 DIMM 组的平均 HbA1C 降低幅度明显大于 PCP 组（-2.4%[SD=2.1]与-0.8%[SD=1.7]，分别，P<0.001）。
结果首次报告了一种创新的 DIMM 模式如何帮助复杂的 T2D 患者实现血糖控制，而不会使 MRC 增加超过对照组。随着 T2D 的患病率不断增加和相关治疗费用的增加，需要确定有效实现血糖控制而不增加复杂性的方法。其他医疗系统可能会考虑应用这种模式，以帮助实现结果指标。
