Original Research

Predictors of HA1c Goal Attainment in Patients Treated With Insulin at a VA Pharmacist-Managed Insulin Clinic

Fed Pract. 2018 November;35(6):S18-S22

References

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Limitations

This study has a few notable limitations. First, it is limited to 1 VA medical center, so our findings may not be extrapolated easily to other institutions of the Veterans Health Administration. Ideally, future studies centered on identifying factors that lead to successful glycemic goal attainment would be helpful from multiple VA institutions. This would encourage more factors to be identified and trends to be strengthened. Ultimately, this would allow for more global changes to the consult process from primary care to pharmacist DSM clinics nationally vs at a local VA institution. Additionally, this study was limited to a specific retrospective time frame, therefore limiting its ability to identify trends. This study also relied on some subjective factors, such as the patient’s self-report of properly following the clinic instructions. Another limitation was that our investigation was not designed to characterize the specific pharmacist’s interventions that improved glycemic control. Future studies would benefit from the inclusion of specific interventions and their effect on glycemic goal attainment.

Conclusion

This retrospective study offers insight to specific patient behavioral factors that correlate with glycemic goal attainment in a VA pharmacist DSM clinic. Behavioral factors linked to HbA_1c goal attainment of < 8% included appointment keeping, bringing glucose meter/glucose log book at least 80% of the time to these appointments, and following clinic instructions. This investigation also found that patients who attain glycemic goals generally do so within 6 months of enrollment. Furthermore, this study provided insight that following the clinic instructions a majority of the time strongly contributes to glycemic goal attainment. We believe that an assessment of patients’ behaviors prior to referrals to diabetes management programs will yield useful information about possible barriers to glycemic goal attainment.