Diabetes Management
Sonya Collins
More than 38 million adults in the United States have diabetes, with the highest prevalence among people of color. Besides the toll it takes on health, quality of life, and life expectancy, the annual economic burden of the condition is estimated in the billions.
Pharmacists are qualified and well positioned to both improve the health of individuals living with diabetes and save payers money. A new study by Rochester-Eyeguokan and colleagues in the July–August 2025 issue of JAPhA adds to the ever-growing body of literature that demonstrates this.
A pharmacist-led comprehensive diabetes management program in a federally qualified health center (FQHC) helped lower the A1C of patients by an average of 1.5 percentage points, “while we showed at least a million dollars in savings as a result of reduction in hospital and emergency room visits,” said Charmaine Rochester-Eyeguokan, PharmD, a coauthor on the study and professor of practice, sciences, and health outcomes research at University of Maryland School of Pharmacy.
Pharmacists’ expertise in an FQHC
The pharmacist-led diabetes management program in an FQHC enrolled 518 patients with T2D, half of whom were Hispanic. The retrospective pre-post analysis study followed the cohort for 2 years.
Patients included in the retrospective study had at least one comprehensive visit with the pharmacist. Visits included any of the following as deemed necessary:
- Evaluation of diabetes control
- Identification of barriers to control and possible solutions
- Evaluation of adherence to medications
- Evaluation of access to medication
- Education on diabetes management and medication use
- Initiation or discontinuation of therapy
Barriers to disease control included access to medications, transportation, and—particularly for the Hispanic patients—lack of understanding due to a language barrier.
Patients might come to a visit not having understood what they had been told in the previous visit. There were misunderstandings about whether and how to use their medication. Some had chosen to use unproven herbal remedies in lieu of prescription drugs.
Through the help of a Spanish language translation line, Rochester-Eyeguokan said, “We provided a lot of education, and then they said, ‘Well, nobody explained that to me before. Now I’m going to take it.’”
Improved outcomes and therapy
The diabetes management program helped patients lower their A1C by an average of 1.5 percentage points. During the 2 years of follow up, the number of people with an A1C of 9% or higher fell by half from 62.9% of patients at baseline to 31.5% at follow up. The proportion of patients with A1C below 7% rose from 0 to 26.8%.
Prescribing in all relevant medication classes, including cardiovascular agents, increased significantly, except for thiazolidinediones.
“Providers were prescribing medications that had no cardiorenal benefits,” Rochester-Eyeguokan said. “It’s cheap, but they didn’t realize that the more expensive therapies have cardio and kidney benefits.”
Though the medications with cardiorenal benefits were more expensive, the program’s pharmacist identified some of these medications on the formulary, Rochester-Eyeguokan said. “We maximized use of those therapies to help the patients get control of their diabetes and their weight.”
Significant savings
The study authors reviewed patient medical records from 1, 3, 6, and 12 months before and after program enrollment. In the year prior to enrollment, 103 patients had 278 hospital or emergency department visits, costing $957,421. In the year following enrollment, 82 patients made 228 visits, costing $657,056, for a savings of $300,365.
Further analysis found an average savings of $1,282 per patient in 12 months. When scaled to 518 patients over a 2-year period, the projected savings totaled $1,328,152. Taking pharmacists’ contracted salaries of $252,729 into consideration, the return on investment was estimated at 4.17:1 over the 2-year period. Patients’ medical visits and medications were free, through the 340B drug pricing program.
Pharmacists improve outcomes in diabetes management
As a testament to the success of the program, since the conclusion of the study, the Maryland-based FQHC has expanded the diabetes program to two additional sites and hired dedicated pharmacists to run the programs.
“Once you have a pharmacist who has focused time for education and for making correct medication choices,” Rochester-Eyeguokan said, “patients will definitely improve. We’ve seen that in many studies.” ■