Glycemic Relapse in a Collaborative Primary Care-Based Type 2 Diabetes Management Program

Background Intensive diabetes management programs reduce hemoglobin A1C (A1C) and help patients achieve glycemic control. However, following program completion, patients are at risk for glycemic relapse. No studies have examined the incidence of glycemic relapse in pharmacist- and Certified Diabetes Care and Education Specialist (CDCES)-led diabetes management programs or the association between patient engagement, patient barriers, and glycemic relapse. Objective The purpose of this study is to evaluate the incidence of glycemic relapse within patients who attained their A1C goal through a health system-wide collaborative primary care-based pharmacist- and CDCES-led type 2 diabetes (T2DM) management program and to identify relapse risk factors. Methods This retrospective cohort study examined patients with T2DM in the diabetes management program with a baseline A1C of at least 9% who attained their A1C goal. The primary outcome was incidence of glycemic relapse. Time to relapse was estimated using Kaplan-Meier curve, and a Cox proportional hazards model was fitted to identify the risk factors for glycemic relapse. Results 362 patients were followed for a median of 10.5 (IQR 12.1) months after program completion; 38 patients (10.5%) experienced glycemic relapse. Kaplan-Meier analysis estimated a 12-month relapse rate of 8.3%. The presence of a medication adherence barrier, a higher number of chronic medications at baseline, baseline BMI of 30-39.9, and insulin at program completion increased risk for glycemic relapse in a univariate model. In multivariate regression, baseline BMI of 30-39.9 remained significant. Older age at program enrollment was associated with significantly decreased relapse risk in both models. Conclusion This study highlights a low incidence of glycemic relapse for patients with T2DM who reach their A1C goal through a collaborative primary care-based pharmacist- and CDCES-led T2DM management program. The presence of risk factors for glycemic relapse may indicate a need for ongoing intensive care despite achieving A1C goal.