Pharmacist-led diabetes clinic improves health outcomes of detainees

The addition of a pharmacist-led diabetes clinic (PLDC) to multidisciplinary care teams in a correctional facility can potentially improve population health outcomes in underserved patients, suggests a study.

“Incarcerated patients often have a high disease burden and poor access to care in the community,” the authors said. “In an effort to ensure glycaemic control and appropriate initiation of statin therapy for cardiovascular (CV) risk reduction, a … PLDC was implemented in a large inner-city jail.”

A pre–post study was performed as a quality improvement initiative among inmate-patients (IPs) diagnosed with type 2 diabetes mellitus, treated with oral antidiabetic medications, managed by PLDC, and with at least two glycosylated haemoglobin A1cs (HbA1c). The change in HbA1c after PLDC was the primary outcome, and the frequency of statin therapy was secondary.

Overall, 240 IPs were eligible for analysis. Their mean HbA1c at baseline and at the last follow-up encounter was 8.2 percent and 7.6 percent, respectively, indicating a change of –0.7 (95 percent confidence interval [CI], –0.41 to –0.93).

The group with the highest initial HbA1c (≥10 percent) showed the most dramatic change, from a mean baseline HbA1c of 11.6 percent to 8.5 percent, a change of –3.1 percent (95 percent CI, –2.5 to –3.7). IPs with an initial HbA1c between 7 percent and 9.9 percent had a change from 8.4 percent to 8.0 percent, a change of –0.4 percent (95 percent CI, –0.1 to –0.7).

Moreover, 141 of the 240 included IPs were not taking statins at baseline. The frequency of statin use increased by 50.4 percent after PLDC. This pilot programme significantly improved glycaemic control and guideline concordance for CV risk reduction.