携手改善健康：利用连续血糖监测和临床药师合作改善 2 型糖尿病未满足患者的血糖控制。

Partnering for Better Health: Using Continuous Glucose Monitoring and Clinical Pharmacist Collaboration to Improve Glycemic Control in Underserved Patients With Type 2 Diabetes.

机构信息

University of Florida College of Pharmacy, Gainesville, Florida; University of Florida College of Medicine, Gainesville, Florida.

University of Florida College of Medicine, Gainesville, Florida.

出版信息

Clin Ther. 2024 Jan;46(1):e7-e11. doi: 10.1016/j.clinthera.2023.10.005. Epub 2023 Oct 28.

DOI:10.1016/j.clinthera.2023.10.005

PMID:38165024

Abstract

PURPOSE

The purpose of this study was to examine the effect of initiating use of a continuous glucose monitor (CGM) in patients being treated for type 2 diabetes mellitus, specifically those who face barriers to obtaining this device because of its cost.

METHODS

This retrospective medical record review compared diabetes control of patients before and after use of a CGM device within a single primary care office. Patient medical records were reviewed 18 months after initial CGM was provided, and only those who received a CGM directly from the clinic were included in the review. Statistical analysis comparing the difference in mean baseline glycosylated hemoglobin (HbA) level with the first HbA level after CGM placement was completed using the paired t test for the primary outcome.

FINDINGS

A total of 41 patients who obtained at least 1 CGM reader and a minimum of a 30-day supply of sensors from the clinic were included in the review. The primary outcome resulted in a significant reduction in the mean (SD) first HbA level after CGM placements of -1.9% (2.5%) (P < .001) with a total of 10 and 22 patients with an HbA level <7% and 8%, respectively. This mean (SD) reduction in HbA level was also seen in both insulin-treated patients (-1.8% [2.8%], n = 30) and non-insulin-treated patients (-2% [2.8%], n=11). The largest reduction in the first HbA level after CGM placement was seen in those patients provided a CGM along with collaborative care with a clinical pharmacist. These patients saw a mean (SD) decrease of -2.5% [2.7%] (n = 26) in their HbA level with a mean (SD) decrease of -0.8% (1.6%) (n = 15) for those not comanaged by the clinical pharmacist.

IMPLICATIONS

The results of this study suggest that the use of CGM in the underserved population can lead to a significant improvement in glycemic control in patients with diabetes, regardless of treatment therapies used. Involving a multidisciplinary team in diabetes management, including clinical pharmacists, may further improve outcomes. Access to these devices in the underserved population may be crucial in reducing the risk of developing complications related to uncontrolled diabetes.

摘要

目的

本研究旨在探讨在接受 2 型糖尿病治疗的患者中，特别是在因设备费用而面临获取障碍的患者中，起始使用连续血糖监测仪（CGM）的效果。

方法

本回顾性病历研究比较了单家基层医疗办公室内患者在使用 CGM 设备前后的糖尿病控制情况。在初始 CGM 提供后 18 个月对患者病历进行了回顾，仅将那些直接从诊所获得 CGM 的患者纳入了回顾。使用配对 t 检验对主要结局进行统计分析，比较初始糖化血红蛋白（HbA）水平与 CGM 放置后首次 HbA 水平的差异。

结果

共有 41 名患者从诊所获得了至少一个 CGM 读数器和至少 30 天的传感器供应，纳入了本次回顾。主要结局是 CGM 放置后首次 HbA 水平显著降低，平均（标准差）为-1.9%（2.5%）（P<0.001），其中分别有 10 名和 22 名患者的 HbA 水平<7%和 8%。胰岛素治疗患者（-1.8%[2.8%]，n=30）和非胰岛素治疗患者（-2%[2.8%]，n=11）也观察到这种 HbA 水平的平均（标准差）降低。在与临床药剂师合作提供 CGM 和协作护理的患者中，CGM 放置后首次 HbA 水平的降低幅度最大。这些患者的 HbA 水平平均（标准差）下降了-2.5%（2.7%）（n=26），而未与临床药剂师共同管理的患者 HbA 水平平均（标准差）下降了-0.8%（1.6%）（n=15）。