title: Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of case management by a clinical pharmacist on glycemic control and preventive measures in patients with type 2 diabetes mellitus.
  
  
  METHODS
  Randomized controlled trial in a university-affiliated primary care internal medicine clinic.
  
  
  METHODS
  We recruited 80 patients with poorly controlled type 2 diabetes mellitus. A clinical pharmacist provided evaluation and modification of pharmacotherapy, self-management diabetes education, and reinforcement of diabetes complications screening processes through clinic visits and telephone follow-up. The main clinical outcome was hemoglobin A1C (HbA1C) level; process measures included HbA1C and low-density lipoprotein measurement, retinal examination, urine microalbumin testing (or use of angiotensin-converting enzyme inhibitors), and monofilament screening for diabetic neuropathy.
  
  
  RESULTS
  Patients in the intervention and control groups were similar in age, sex, mean HbA1C levels (10.1% and 10.2%, respectively; P = .65), and current treatment regimens at baseline. Patients who received case management by the clinical pharmacist achieved greater reduction in HbA1C levels than those in the control group (2.1% vs 0.9%, P = .03). Three of the 5 process measures were conducted more frequently in the intervention group than the control group, including low-density lipoprotein measurement (100.0% vs 85.7%, P = .02), retinal examination (97.3% vs 74.3%), and monofilament foot screening (92.3% vs 62.9%).
  
  
  CONCLUSIONS
  Proactive diabetes case management by a pharmacist substantially improved glycemic control and diabetes process-of-care measures. This approach, integrated with and based in the primary care setting, was an effective and efficient approach to improving care, especially for those with poor glycemic control at baseline.
authors.affiliation: College of Pharmacy, University of Michigan, Ann Arbor, USA.
authors.forename: Hae Mi
authors.initials: HM
authors.lastname: Choe
authors.forename: Sonya
authors.initials: S
authors.lastname: Mitrovich
authors.forename: Daniel
authors.initials: D
authors.lastname: Dubay
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D019090:Case Management; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D024382:Professional Role; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin