Improved Glycemic Control With Minimal Change in Medication Regimen Complexity in a Pharmacist-Endocrinologist Diabetes Intense Medical Management (DIMM) “Tune Up” Clinic

Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusions and Relevance: 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.