After the diabetes care trial ends, now what? A 1-year follow-up of the RxING study

Abstract

Introduction: There is strong evidence that pharmacist care improves patients' glycaemic control. However, the sustainability and durability of such interventions beyond the research period is not known. RxING was the first trial of pharmacist prescribing in diabetes and it showed an improvement in glycated haemoglobin (HbA1c) of 1.8% over 6 months.

Objective: 1° objective: To evaluate glycaemic control in the RxING study patients 12 months after the end of the formal study follow-up. 2° objective: To assess the patients' risk of cardiovascular events in the next 10 years.

Methods: We contacted the participating pharmacists to check if the patients who participated in the RxING study are still taking insulin, the dose of insulin they are taking, and their HbA1c. There were no mandated follow-up visits with the pharmacist after the study completion.

Results: A total of 100 patients with poorly controlled type 2 diabetes were enrolled in the original RxING study; 93 of them completed the study, while 83 participated in the 12-month follow-up. Seventy-five patients were still taking insulin, with the average dose increasing from 31.1 units (SD 18.4) at study completion to 37.4 units (SD 30.8) (95% CI -13.3 to 0.88, p=0.085). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9) at study completion (95% CI 1.4 to 2, p <0.001), and increased to 8.1% (SD 1.3) 12 months later (95% CI -1.1 to -0.5, p <0.001 vs study completion).

Conclusions: Twelve months after completing the intervention, approximately half of the glycaemic control gains were lost. This highlights the importance of structured follow-up with the pharmacist in this patient population.

Trial registration number: clinicaltrials.gov; Identifier: NCT01335763.

Keywords: PUBLIC HEALTH.

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Figures

Figure 1

Patient's enrolment and follow-up flow chart.

Figure 2

Glycated haemoglobin (HbA1c) change with the intervention and 12 months postcompletion * Dotted line indicates the completion of the intervention period.