Impact of a Pharmacy-Led Post-Transplant Diabetes Mellitus Clinic in Solid Organ Transplant Recipients
1University Health - University Hospital, San Antonio, TX, 2College of Pharmacy, University of Incarnate Word, San Antonio, TX
Meeting: 2022 American Transplant Congress
Abstract number: 153
Keywords: Hyperglycemia, Kidney transplantation, Liver transplantation, Post-transplant diabetes
Topic: Clinical Science » Pharmacy » 30 - Non-Organ Specific: Clinical Pharmacy/Transplant Pharmacotherapy
Session Information
Session Name: Non-Organ Specific: Clinical Pharmacy/Transplant Pharmacotherapy
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 5, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 6:10pm-6:20pm
Location: Hynes Room 312
*Purpose: To evaluate the impact of a pharmacy-led post-transplant diabetes mellitus (DM) clinic.
*Methods: This retrospective chart review from 08/01/20 to 6/30/21 evaluated adult kidney transplant recipients and liver transplant recipients with DM with a pharmacy DM clinic consult. Patients with Type 1 DM or on an insulin pump were excluded from the study. Primary outcomes included change in hemoglobin A1c (HbA1c) and self-monitored blood glucose (SMBG) levels from baseline (pre-consult) to time of consult completion (post-consult). SMBG were evaluated at fasting, pre-lunch, and pre-dinner. Secondary outcomes included change in total daily dose (TDD) of insulin, weight, and body mass index (BMI).
*Results: Forty-eight KTR and 16 LTR met inclusion criteria (n=64). Median duration of the pharmacy consult was 93 days (IQR 51-162) with a median of 4 (IQR 3-7) visits per patient. Median Hgb A1c was 8% (IQR7-9), and 7% (6-8) in the pre- and post- consult, respectively. Change in fasting SMBG (p<0.0001), pre-lunch SMBG (p<0.0001), and pre-dinner SMBG (p<0.0001) demonstrated a significant benefit (Table 1). TDD of insulin, weight, and BMI pre- and post-consult showed no statistically significant difference. Twelve patients (23%) on insulin pre-consult were transitioned off of insulin and 35 patients (55% of all patients) were transitioned to non-insulin therapies. Evaluation of anti-hyperglycemic agents utilized pre- and post-consult is provided in Table 2.
*Conclusions: Patients enrolled in the transplant pharmacy DM clinic demonstrated significant improvements in glycemic control. Even though HbA1c was not significantly different, the improvements in SMBG suggest a trend toward HbA1c improvement and type 2 error. Patients were able to maintain their weight, while also not requiring additional insulin post-consult. Possibly the most impactful outcome we found was that transplant pharmacists were successful in managing DM and were able to transition patients to non-insulin therapies. These therapies are often more manageable than insulin and have shown either long-term cardiovascular or weight-loss benefits in the non-transplant population. Overall, the results of this study suggest the implementation of a transplant pharmacy DM clinic may provide adequate management of DM with closer pharmacotherapeutic monitoring.
To cite this abstract in AMA style:
Sweiss H, Hall R, Flores M, Bhayana S, Patel R, Long C. Impact of a Pharmacy-Led Post-Transplant Diabetes Mellitus Clinic in Solid Organ Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-a-pharmacy-led-post-transplant-diabetes-mellitus-clinic-in-solid-organ-transplant-recipients/. Accessed December 3, 2024.« Back to 2022 American Transplant Congress