Impact of Pharmacists in Therapeutic Optimization Relative to the 2020 American Diabetes Association Standards of Medical Care in Diabetes Guidelines in Patients with Clinical Atherosclerotic Cardiovascular Disease.

In 2020, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes Guidelines newly recommended adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist in patients with both type 2 diabetes and atherosclerotic cardiovascular disease, regardless of hemoglobin A1c (HbA1c) levels. In this study, the primary objective was to assess the pharmacist's role in the therapeutic optimization of patients with both type 2 diabetes and atherosclerotic cardiovascular disease relative to the new recommendations. The secondary objectives were to assess other factors affecting therapeutic optimization and clinician familiarity with the recommendations. This study, conducted at the East Hawai.i Health Clinic, included 60 patients with type 2 diabetes and atherosclerotic cardiovascular disease. Anonymous surveys were sent to clinicians at the clinic to assess recommendation familiarity. Patients seen by a pharmacist were significantly more likely to be therapeutically optimized per the 2020 ADA guidelines than those not seen by a pharmacist. HbA1c and age also influenced SGLT-2/GLP-1 therapy use. All clinicians were more likely to prescribe SGLT-2/GLP-1 therapy for patients with uncontrolled HbA1c but were less likely to prescribe additional therapy for patients with controlled HbA1c, even in patients with previous atherosclerotic events.