ecently, I completed a research project based on treatment patterns among patients with diabetes 80 years and older in conjunction with a couple student pharmacists. It is an exciting moment for student pharmacists who created the protocol, collected the data and designed a poster for presentation at a national meeting. While this research project was not a randomized controlled trial or funded by an organization, it provided some findings that I wanted to share with you. The main purpose of our project was to evaluate the treatment patterns of patients with diabetes who are older than 80 years old, in a rural health/family medicine setting to determine if the American Diabetes Association (ADA) and American Geriatrics Society (AGS) guideline goals are being met.
We conducted this retrospective chart review in a rural health/family medicine clinic. We screened charts and included if the following inclusion criteria were met: a diagnosis of diabetes (type 1 or 2); age 80 years or older; and prescribed at least one blood glucose lowering agent. The primary outcome was percentage of patients with controlled or uncontrolled diabetes in a rural health/family medicine clinic.
Based on the results, patients were more likely to meet A1C goal if currently prescribed metformin, compared to using other antidiabetic therapies
We analyzed 117 patient charts, and of all patients analyzed, 49.1 percent were on metformin therapy, 31.9 percent were on basal insulin therapy, 47.1 percent were on an ACE inhibitor, 96 percent were on statin therapy. These medications are recommended by the ADA and AGS to adequately treat diabetes mellitus and other interrelated chronic conditions. In addition, 84.8 percent of patients (73.7 percent with A1C less than 7.5 percent and 11.1 percent with A1c between 7.5 to 8 percent) met A1C goals of less than 8 percent, per AGS guidelines. Of those not taking metformin, 82 percent were at A1C goal of less than 8 percent. There was a statistically significant association between meeting A1C goal and the number of antidiabetic medications for the management of diabetes (p equals 0.031). For other endpoints, a statistically significant association was found between number of medications and attained blood pressure goals, per national hypertension guidelines (p equals 0.038).
Based on the results, patients were more likely to meet A1C goal if currently prescribed metformin, compared to using other antidiabetic therapies. In addition, patients with more antihypertensive medications were less likely to have controlled blood pressure.
While this project was small, I wanted to share this information with you and invite you to share your research with the group. What type of research do you conduct in your practice site? How many research projects do you conduct in a year? Do you involve students or residents? Or only collaborate with fellow peers and colleagues?
Share your current or previous research and findings with the group so we can learn from each other.
About the Author
Jennifer Clements received her Doctorate of Pharmacy from Campbell University in 2006 and completed a primary care residency at a Veterans Affairs Medical Center in 2007. She is also a certified diabetes educator and board certified in pharmacotherapy. Currently, she is the Interim Chair and Associate Professor in the Department of Pharmacy Practice at Presbyterian College School of Pharmacy.