Title: Impact of Embedded Clinical Pharmacy Services on Glycemic Control in an Internal Medicine Clinic
Authors: Kisara Thompson, Tacorya Adewodu, Andrew Bundeff, Molly Hinely, Danielle Baker, Michael DeWitt
Objective: Evaluate the effect of clinical pharmacy services on A1c reduction in patients with type 2 diabetes and a baseline A1c of ≥ 8%, compared with patients who were managed by usual care, defined as a primary care provider acting as the sole responsible diabetes managing provider.
Background: Uncontrolled type 2 diabetes results in serious health complications. Hemoglobin A1c is used to measure average blood glucose over the past three months and is used to guide optimal treatment plans. Studies have demonstrated an improvement in microvascular and macrovascular complications in patients with improved glycemic control in those with type 2 diabetes.
The Winston-Salem East Clinic, a part of Atrium Health Wake Forest Baptist, is the primary study site. It is a medical resident-run internal medicine clinic that serves a large population of underserved and uninsured patients. Since March of 2023, a clinical pharmacist practitioner (CPP), has been integrated into the clinic two days of the week working under collaborate practice agreements with supervising physicians. Patients with uncontrolled type 2 diabetes are referred to the CPP to provide medication management.
Methods: This single-center, retrospective, cohort study compared mean percent change of A1c managed by a primary care provider (PCP) versus A1c managed by a CPP. Patient data was collected between July 1st, 2023 and October 31st, 2025. Patients included were ≥ 18 years of age, diagnosed with type 2 diabetes, and those who had completed at least two follow-up visits with their PCP or clinical pharmacist. Patients excluded were the following: type 1 diabetes, managed by endocrinology, seen by non-network PCPs, pregnant, lost to follow-up – defined as no additional follow-up appointments or A1c labs drawn within the study time frame. Demographic information such as sex assigned at birth, age at encounter, race and ethnicity and primary payor were collected. The primary outcome assessed was mean percent change in A1c at 90- and 180- days with and without established clinical pharmacy management. Secondary outcomes included clinical interventions made, number of continuous glucose monitors (CGMs) prescribed, and incidence of diabetes related emergency department visits and/or hospitalizations during the study time frame. Patients were identified through a data sorting platform within the electronic health record.
Results: A total of 144 patients were enrolled in the study, with 72 patients per study group. The primary endpoints were statistically analyzed by linear regression. Adjusting for baseline A1c, there is an average reduction of 1.2 percentage points in A1c measured at 90-days in patients managed by a pharmacist, compared to patients managed by usual care (95% CI: -2.0 – (-0.36), p-value: 0.005). Adjusting for baseline A1c, there is an average reduction of 1.3 percentage points in A1c measured at 180-days in patients managed by a pharmacist, compared to patients managed by usual care (95% CI: -2.1 – (-0.46), p-value: 0.003). Pharmacist managed patients were approximately eight times more likely to have their insulin therapy changed compared to patients who were managed by usual care (95% CI: 1.3 – 2.9, p-value: 0.001). There were no differences associated with rates of change in other medication therapy changes. During the study period, pharmacy managed patients had approximately a 53-point higher prescription rate for a CGM than those managed by usual care. There were no differences detected in the incidence rates between pharmacy managed and usual care patients in regard to ED and/or hospitalizations related to type 2 diabetes within the study period.
Conclusions: Among patients with type 2 diabetes and a baseline A1c ≥ 8%, clinical pharmacy management was associated with a statistically significant greater reduction in A1c compared with usual care management with mean reduction of 1.2 and 1.3 percentage points at 90-days and 180-days, respectively.
