Diabetes Performance Improvement Program With Continuous Glucose Monitoring, Pharmacist Intervention, and Team Management

Abstract

The growing prevalence of diabetes in the USA continues to be a significant public health concern. A significant proportion of patients with type 2 diabetes (T2D) have elevated glucose levels, as evidenced by a glycated hemoglobin (HbA1c) level > 9.0%. Persistent hyperglycemia results in the development of chronic macrovascular and microvascular complications. Previous strategies to assist this high-risk population in achieving optimal glycemic control have not been as successful as desired. As the demand for healthcare providers and services continues to grow at an unprecedented pace, the USA is facing a national deficit in physicians, nurse practitioners, and physician assistants. Conversely, the number of pharmacists is projected to increase at a rate of 3% annually over the next three decades. Studies have demonstrated that pharmacist involvement in diabetes patient management has resulted in improvements in HbA1c, lowering of low-density lipoprotein (LDL)-cholesterol levels, and achievement of blood pressure targets. This suggests the potential for pharmacists to play a key role in narrowing the gap. We implemented a Diabetes Performance Improvement Program (DPIP) that facilitates a comprehensive lifestyle intervention designed to improve diabetes management and outcomes. The DPIP care team comprises endocrinologists, certified diabetes educators, pharmacists, and supporting staff. The intervention includes utilizing continuous glucose monitoring (CGM) supported by diabetes self-management training (DSMT) and medical nutrition therapy (MNT) delivered by a certified diabetes education specialist (CDES) and registered dietitian (RD). This article reviews the evidence supporting the use of an interdisciplinary team-based approach to diabetes care, describes the DPIP components, and provides guidance for implementing the program in clinic-community settings.