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Glycemic relapse in a collaborative primary care-based type 2 diabetes management program. J Am Pharm Assoc (2003) 2021;61(4):476-483.e3

Date

03/16/2021

Pubmed ID

33715974

DOI

10.1016/j.japh.2021.02.007

Scopus ID

2-s2.0-85102417334

Abstract

OBJECTIVES: The purpose of this study is to evaluate the incidence of glycemic relapse in patients who attained their glycosylated hemoglobin (A1C) goal through a health system-wide collaborative primary care-based pharmacist- and Certified Diabetes Care and Education Specialist (CDCES)-led type 2 diabetes (T2D) management program and to identify relapse risk factors.

METHODS: This retrospective cohort study examined patients with T2D in the diabetes management program with a baseline A1C of at least 9% who attained their A1C goal. The primary outcome was incidence of glycemic relapse. Time to relapse was estimated using Kaplan-Meier curve, and a cox proportional hazards model was fitted to identify the risk factors for glycemic relapse.

RESULTS: Three hundred sixty-two patients were followed-up for a median of 10.5 (interquartile range 12.1) months after program completion; 38 patients (10.5%) experienced a glycemic relapse. Kaplan-Meier analysis estimated a 12-month relapse rate of 8.3%. The presence of a medication adherence barrier, presence of a higher number of chronic medications at baseline, presence of a baseline body mass index (BMI) of 30-39.9, and use of insulin at program completion increased risk for glycemic relapse in a univariate model. In multivariate regression, baseline BMI of 30-39.9 remained statistically significant. Older age at baseline was associated with a statistically significantly decreased relapse risk in both models.

CONCLUSION: This study highlights a low incidence of glycemic relapse for patients with T2D who reach their A1C goal through a collaborative primary care-based pharmacist- and CDCES-led T2D management program. The presence of risk factors for glycemic relapse may indicate a need for ongoing intensive care despite achieving A1C goal.

Author List

Wheeler SE, Struebing T, Drury RLC, Caruso L, Teng BQ, Brazauskas R, Hanson RJ, Crotty BH

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Bradley H. Crotty MD Associate Professor in the Medicine department at Medical College of Wisconsin
Bi Qing Teng Biostatistician I in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Blood Glucose
Diabetes Mellitus, Type 2
Glycated Hemoglobin A
Humans
Hypoglycemic Agents
Primary Health Care
Recurrence
Retrospective Studies