(1073) Implementation and Evaluation of a Pharmacist-led Glucagon-like peptide-1 Receptor Agonist Titration Service in a Primary Care Clinic

Objectives: The objective of this study is to describe the implementation and evaluation of an ambulatory care pharmacist-led glucagon-like peptide-1 receptor agonist (GLP-1 RA) titration service. Patients with type 2 diabetes are increasingly being prescribed GLP-1 RA’s which require frequent follow up for tolerability and dose optimization. To prevent clinical inertia, ambulatory care pharmacists are positioned to provide titration services to reduce the burden on primary care providers.

Methods: This single-center, prospective study evaluated 108 patients from two primary care clinics followed by an ambulatory care pharmacist from September 2022 to November 2023. Patients were included if they had been referred to the pharmacist for GLP-1 RA titration within the study period, had a diagnosis of type 2 diabetes, were 18 to 75 years old, and not pregnant. The primary outcome was the absolute change in glycosylated hemoglobin (A1c) from baseline to 3-6 months post titration. Secondary outcomes included change in weight, number of diabetes medications at baseline and after dose optimization, the percentage of patients achieving the diabetic bundle quality metrics related to the Healthcare Effectiveness Data and Information Set (HEDIS), number of prescriptions dispensed from the health system pharmacy, average total time needed per patient, and pharmacist full-time equivalents required.

Results: To date, ninety patients have completed titration, data collection, and are included in these preliminary results. Our study enrolled 108 patients with a mean baseline A1c of 8.4. The expected close of study is November of 2023. Eight patients stopped treatment during titration. The mean change in A1c from baseline to 3-6 months post titration was –2.0%. The average change in weight was –7.6 kg from baseline. The average patient decreased the number of diabetes medicines they were on from baseline from 2.5 to 2.1. The percentage of patients meeting the diabetic bundle goals were 96.5% for blood pressure under 140/90 mm Hg, 95.3% for A1c under 8%, and 85% for nephropathy labs. A total of 212 prescriptions were captured and dispensed at the health system’s pharmacy. The average patient required 6.2 interactions with the pharmacist and 87 total minutes.

Conclusions: Ambulatory care pharmacists can effectively optimize dosing on GLP-1 RA’s to improve patient A1c’s, meet quality-based metrics, and reduce the burden on primary care providers.