Lessons learned from clinical pharmacists' review of glucometer download reports in the primary care setting

Purpose: The purpose of this study was to evaluate the incidence and types of diabetes-related medication changes completed by clinical pharmacists when reviewing glucometer download reports in a primary care setting.  

Methods: Data was collected from  patient encounters involving a glucometer download by a clinical pharmacist during a seven month period (October 2011 through May 2012).  Collected information included:  type of diabetes, current diabetes treatments, lessons learned from the glucometer review and type of diabetes medication intervention that occurred during the encounter.  Each clinic had a collaborative practice agreement which allowed the pharmacist to adjust medications.

Results: A total of 305 glucometer downloads were completed during the study period.  The majority of patients had type 2 diabetes (91.5%).  Medication adjustments were made during the visit of 118 of 305 patients (38.7%). Only 48 of the 305 (15.7%) of the reports were reviewed with the provider.  The most common interventions were increasing insulin dose (n=60) or decreasing insulin dose (n=16).  An oral medication was either added (n=15) or removed (n=2) during the visit.  Medication interventions were based solely on review of glucometer data for 55 of 118 (46.6%) patients and unrelated to review of A1C testing.

Conclusion: Review of glucometer data by clinical pharmacists can assist with medication dosage titration, especially insulin-requiring patients.  Many of the medication interventions occurred when A1C testing did not factor into the treatment decision.  Analyzing glucometer reports can provide additional insight related to pattern management and glucose trends over time.