2020 Volume 22 Issue 2 Pages 85-92
To clarify the results of the regional cooperation critical pathway for diabetes mellitus (hereinafter referred to as the “DM pathway”), factors related to the reduction and maintenance of glycemic control associated with diabetes mellitus were analyzed. 74 patients who visited our DM pathway outpatient clinic between 2004 and 2016 were examined. The factors assessed were gender, age at the start of the DM pathway, HbA1c, antidiabetic drugs being used, instructions provided by pharmacists, number of years of consultation with the DM pathway and diabetes mellitus classification. Patients using insulin alone were grouped with those using insulin with oral hypoglycemic agents (OHAs) and classified as the insulin (INS) group, while patients using OHA alone were grouped with those using no insulin and classified as the OHA group. The primary endpoint was the time at which a patient introduced to the DM pathway achieved HbA1c <7% twice in succession. The relationship between the primary endpoint and each factor was examined using a survival time analysis. Therapeutic agents were the only factors affecting the achievement rate. The hazard ratio for achievement was 0.47 (95% confidence interval: 0.23-0.97) in the INS group compared to the OHA group. Patients using insulin had lower HbA1c reduction and maintenance achievement rates and showed longer achievement times than patients using OHA alone. Aggressive interventions in patients using insulin may be a modifiable factor. Future challenges include establishing an improved regional cooperation pathway that includes insurance pharmacies. This will require sharing the contents of the instructions provided by our pharmacists and problems with the DM pathway and facilitating cooperation between core hospitals and clinics in the relevant areas, as well as cooperation between hospital pharmacists and community pharmacists.
