Maintenance of Goal Blood Pressure, Cholesterol, and A1C Levels in Veterans With Type 2 Diabetes After Discharge From a Pharmacist-Managed Ambulatory Care Clinic

Feature Article

St. Louis College of Pharmacy and VA St. Louis Health Care System—John Cochran Division, St. Louis, MO

Diabetes Spectrum 2015 Nov; 28(4): 237-244. https://doi.org/10.2337/diaspect.28.4.237

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FIGURE 1.
Kaplan-Meier curve for time to failure to maintain SBP goal (n = 42).
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FIGURE 2.
Kaplan-Meier curve for time to failure to maintain LDL cholesterol goal (n = 35).
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FIGURE 3.
Kaplan-Meier curve for time to failure to maintain A1C goal (n = 22).

TABLE 1.

Study Population (n = 69) Characteristics at Discharge (Unless Otherwise Specified)

Characteristic	Value (mean ± SD or n [%] unless otherwise noted)
Age at enrollment (years)	64.5 ± 9.7
Male sex	67 (97.1)
Body weight (lb)	225 ± 45.1
BMI (kg/m²)	32.41 ± 6.0
SBP (mmHg)	126 ± 14.5
Current smoker	11 (15.9)
Copay exempt	36 (52.2)
Chronic kidney disease	6 (8.7)
Coronary artery disease	2 (2.9)
Myocardial infarction	2 (2.9)
Coronary artery bypass grafting	5 (7.2)
Percutaneous intervention	4 (5.8)
Cerebrovascular accident/transient ischemic attack	3 (4.3)
Heart failure	6 (8.7)
Chronic obstructive pulmonary disease	7 (10.1)
Peripheral artery disease	3 (4.3)
Abdominal aortic aneurysm	1 (1.4)
Serum creatinine (mg/dL)	1.18 ± 0.3
LDL cholesterol (mg/dL)	82.5 ± 27.4
Total cholesterol (mg/dL)	145.4 ± 33.1
A1C (%)	median 6.9 (interquartile range 1.7)
Microalbumin to creatinine ratio (μg/mg)	66.9 ±116.2
Concurrent medications	13 ± 6
Insulin use	27 (39.1)
Duration of clinic enrollment (months)	6.4 ± 6.0
Clinical pharmacy visits during enrollment	4.2 ± 2.8
PCP visits during clinic enrollment	1.8 ± 1.6

TABLE 2.

Clinical Characteristics of Study Population (n = 69) at Baseline and Clinic Discharge

Characteristic	Baseline	Discharge	Change (%)
SBP (mmHg; mean SD)	138.5 ± 14.8	126 ± 14.5	–9
LDL cholesterol (mg/DL; mean SD)	95.4 ± 27.5	82.5 ± 27.4	–13
A1C (%; median [interquartile range])	6.9 (1.5)	6.9 (1.7)	none
Total cholesterol (mg/dL; mean SD)	170.6 ± 50.6	145.4 ± 33.1	–15
Current tobacco users (n)	12	11	–8.6

TABLE 3.

Clinical Characteristics of Individual Goal Maintenance Failure Groups at Baseline and Discharge

Characteristics	Baseline	Discharge	Absolute Reduction
SBP (mmHg; mean ± SD; n = 42)	135.6 ±15.5	119.1 ± 10.5	–16.5
DL cholesterol (mg/dL; mean ± SD, n = 35)	101.4 ± 31.8	74.5 ±17.0	–26.9
A1C (%; median [interquartile range]; n = 22)	6.5 (0.48)	6.4 (0.65)	–0.1

TABLE 4.

Factors Associated With Increased Rate of Failure to Maintain Goal

Factor	HR	SD	P
SBP goal maintenance failure group
Chronic kidney disease	13.16	7.48	0.026
Heart failure	3.839	3.73	0.019
Coronary artery bypass graft surgery	3.869	3.32	0.008
A1C goal maintenance failure group
Older age at clinic enrollment	1.08	0.15	0.015
Higher A1C at clinic discharge	2.61	2.05	0.028