Pharmacist-led shared medical appointments increased the proportion of diabetic and depressed patients achieving A1C <7% compared to standard care (29.6% vs 11.9%; OR 3.6, 95% CI 1.1-12.3).
RCT (n=88)
Does pharmacist-led group shared medical appointments added to standard care improve attainment of A1C <7% in older adults with type 2 diabetes and comorbid depression?
Pharmacist-led shared medical appointments significantly improved glycemic control and cardiovascular risk factors in older adults with type 2 diabetes and comorbid depression.
Effect estimate: OR 3.6 (95% CI 1.1 to 12.3)
Absolute Event Rate: 29.6% vs 11.9%
BACKGROUND: Depression is associated with poor glycemic control, increased number of microvascular and macrovascular complications, functional impairment, mortality, and 4.5 times higher total health care costs in patients with diabetes. Shared medical appointments (SMAs) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support, counseling, problem solving, and improved access to care. OBJECTIVE: To test the efficacy as assessed by attainment of a hemoglobin A(1c) (A1C) 6.5%. VA-MEDIC-D consisted of 4 once-weekly, 2-hour sessions followed by 5 monthly 90-minute group sessions. Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes, lipids, smoking, and blood pressure. No pharmacologic interventions for depression were provided. The change in the proportion of participants who achieved an A1C <7% at 6 months was compared. RESULTS: Compared to standard care (n = 44), a lower proportion of patients in VA-MEDIC-D (n = 44) had systolic blood pressure (SBP) <130 mm Hg at baseline, but were similar in other cardiovascular risk factors and psychiatric comorbidity. The change in the proportion of participants achieving an A1C <7% was greater in the VA-MEDIC-D arm than in the standard care arm (29.6% vs 11.9%), with odds ratio 3.6 (95% CI 1.1 to 12.3). VA-MEDIC-D participants also achieved significant reductions in SBP, low-density lipoprotein cholesterol, and non-high-density lipoprotein (HDL) cholesterol from baseline, whereas significant reductions were attained only in non-HDL cholesterol with standard care. There was no significant change in depressive symptoms for either arm. CONCLUSIONS: Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms.
Taveira et al. (Tue,) conducted a rct in Type 2 diabetes mellitus with comorbid depression (n=88). Pharmacist-led group shared medical appointments (VA-MEDIC-D) vs. Standard care was evaluated on Attainment of a hemoglobin A1c (A1C) <7% at 6 months (OR 3.6, 95% CI 1.1 to 12.3). Pharmacist-led shared medical appointments increased the proportion of diabetic and depressed patients achieving A1C <7% compared to standard care (29.6% vs 11.9%; OR 3.6, 95% CI 1.1-12.3).