Evaluation of a pharmacist-led personal continuous glucose monitor workflow to improve glycemic management in an internal medicine clinic.

BACKGROUND: The use of personal continuous glucose monitors (CGMs) in patients with diabetes has increased substantially and is expected to continue to increase as CGMs become more affordable and insurance plans improve coverage. The utilization of CGMs has improved diabetes management and reduced hypoglycemic events. OBJECTIVES: To create pharmacist-led personal CGM workflow and evaluate its impact on glycemic management in patients with diabetes. PRACTICE DESCRIPTION: The study took place at an Internal Medicine Clinic. The practice providers include 2 medical doctors, 5 physician assistants, 2 nurse practitioners, and 1 clinical pharmacist. PRACTICE INNOVATION: To create and implement a sustainable pharmacy led CGM workflow for enhanced CGM use within an internal medicine clinic. EVALUATION METHODS: This was a prospective, investigator-initiated pilot study conducted at an Atrium Health Internal Medicine clinic over 28 weeks. In this pilot, 42 patients were qualifying candidates with diabetes and personal CGM use. In addition, 30 patients were followed until study completion and included into final analysis. RESULTS: The average baseline A1c was reduced from 8.3% to 7.1% over a 3- to 6-month period. The pharmacist-led CGM workflow revealed a statistically significant reduction in A1c from baseline by an average of 1.2% (95% CI -0.6 to -1.8, P = 0.0006). On average, patients were enrolled for 19.9 weeks and had an average of 5 visits during this time. During the study duration, 100 medications changes were implemented under the existing clinical pharmacist practitioner agreement between the pharmacists and the provider. Overall, 58 Current Procedural Terminology 95251 codes were billed yielding $7052.00 in billed CGM services for the clinic. This project generated 40.6 provider relative value units. CONCLUSION: The utilization of a pharmacist-led personal CGM workflow can improve diabetes outcomes.

Evaluation of density variations to determine impact on sterile compounding.

PURPOSE: To determine the density variation between (1) the measured density and manually calculated density, (2) density variation of different lots, and (3) density variation of different drug manufacturers in order to support institutions using gravimetric compounding methods. SUMMARY: Seventeen sterile injectable ingredient (drug) vials frequently used to make compounded sterile products (CSPs) were identified based on the ability to ensure that for each drug there were vials produced by 2 different manufacturers and 2 lots produced by the same manufacturer. Each drug's density was measured using a density meter and by manual calculation using the institution's density formula. Density differences were compared between the 2 different methods. Overall, the average drug density difference between the measured versus calculated density was determined to be 0.022. Further analysis revealed the average difference between the different lot numbers of the same manufacturers was 0.005 for the nonhazardous drugs and 0.0001 for the hazardous drugs. The average difference between the different manufacturers of the same drug was determined to be 0.008 for the nonhazardous drugs and 0.001 for hazardous drugs. CONCLUSION: No clinically meaningful difference exists when manually calculating a drug's density compared to measuring a drug's density using a density meter. In addition, there does not appear to be a sizeable density variation between the same drugs in separate lots or produced by different manufacturers.