Association between a clinical pharmacist–led multimodal remote medication intervention and individualized treatment outcomes in patients with type 2 diabetes mellitus
TL;DR
In this single-center retrospective study, a clinical pharmacist-led multimodal remote medication intervention was associated with more favorable glycemic and cardiometabolic indices, lower HOMA-IR, higher estimated HOMA-β, higher medication adherence, and higher attainment of individualized treatment targets.
Abstract
Objective To evaluate the association between a clinical pharmacist-led multimodal remote medication intervention and glycemic control, insulin resistance and estimated β-cell function, medication adherence, and individualized treatment outcomes among patients with type 2 diabetes mellitus (T2DM). Methods A single-center, retrospective, controlled study design was used. A total of 163 patients with T2DM treated in the Endocrinology Department of our hospital between January 2022 and December 2024 were included and allocated, according to the type of pharmaceutical service actually received, to an intervention group (IG, n=85; electronic medical records confirmed receipt of a multimodal remote medication intervention) or a control group (CG, n=78; standard pharmaceutical care). Glycemic indices (HbA1c, FPG, 2hPG), lipid profile and blood pressure, HOMA-IR, HOMA-β, MMAS-8 score, individualized target-attainment rates, and adverse drug reaction data were extracted from the electronic medical record system at baseline and 6 months after intervention, and subgroup analyses were performed according to age, insulin use, and baseline medication adherence. Analysis of covariance (ANCOVA), 1:1 nearest-neighbor propensity score matching, inverse probability of treatment weighting, and Bonferroni correction were used to evaluate the robustness of the findings; subgroup analyses were exploratory. Results Baseline characteristics were comparable between the two groups (all P>0.05). After intervention, HbA1c, FPG, and 2hPG were all significantly lower in the IG than in the CG (all P<0.001; ANCOVA-adjusted between-group differences: HbA1c −0.72%, FPG −0.96 mmol/L, 2hPG −1.59 mmol/L). TC, TG, LDL-C, SBP, and DBP were all significantly lower, and HDL-C significantly higher, in the IG (all P<0.05). HOMA-IR was significantly lower and HOMA-β significantly higher in the IG (both P<0.001). MMAS-8 scores and the proportion of patients with high adherence were significantly greater in the IG (P<0.001). HbA1c attainment, LDL-C attainment, and composite triple-target attainment rates were all higher in the IG (all P<0.01). The overall incidence of adverse drug reaction events was lower in the IG (P<0.05). Exploratory subgroup analyses showed that, within strata defined by age, insulin use, and baseline adherence, the direction of between-group differences in the primary outcomes was generally consistent. Results of the PSM cohort (n=59 pairs) and the IPTW sensitivity analysis were directionally consistent with the primary analysis. Conclusion In this single-center retrospective study, a clinical pharmacist-led multimodal remote medication intervention was associated with more favorable glycemic and cardiometabolic indices, lower HOMA-IR, higher estimated HOMA-β, higher medication adherence, and higher attainment of individualized treatment targets. Because of the non-randomized, observational design, and because HOMA indices are indirect surrogate markers, these associations do not establish causality, the independent contribution of any single intervention component, or recovery of β-cell function.