Intervention by clinical pharmacists can improve blood glucose fluctuation in patients with diabetes and acute myocardial infarction: A propensity score-matched analysis

Abstract

Acute phase hyperglycemia and exaggerated glucose fluctuation may be associated with poor outcomes in diabetic patients after acute myocardial infarction (AMI). This study aimed to determine whether intervention by clinical pharmacists can mitigate blood glucose and glucose fluctuations in these fragile patients. This retrospective study enrolled patients with diabetes and AMI, from 1 January 2019 to 30 June 2020 in our institution. Blood glucose and glucose fluctuations were calculated before and after the pharmacist's intervention and between patients who underwent intervention and those who did not. Propensity score matching (PSM) was used to reduce the impact of patient characteristics on the results. A total of 170 patients were included in our primary analysis, including 29 patients who received the pharmacist intervention and 141 patients who did not. After the pharmacist's intervention, blood glucose (fasting blood glucose-FBG, from 11.9 to 9.8; postprandial blood glucose-PBG, from 15.3 to 13.2; mean blood glucose-BG, 14.5 to 12.3 mmol/L; p < .001), and glucose fluctuations (standard deviation of blood glucose-SDBG, from 3.8 to 3.0, mmol/L, p = .005) were significantly improved. Before PSM, no clear effects were found in intervention versus nonintervention patients, in terms of blood glucose and glucose fluctuation indicators, except for FBG (9.3 vs. 8.0. mmol/L, p = .005). Further analysis indicated a high incidence of FBG <7.8 mmol/L in nonintervention versus intervention patients (51.5% vs. 27.6%, p = .003). After PSM, a significant reduction in blood glucose fluctuation (SDBG, 3.0 vs. 4.1, p = .031; PBGE, 2.1 vs. 4.1, p = .017; LAGE, 4.7 vs. 7.2, mmol/L, p = .004), and PBG (11.1 vs. 13.0, mmol/L, p = .048) was observed in the intervention group than in the nonintervention group. The clinical pharmacist intervention contributed to improved outcomes, specifically, in reducing blood glucose fluctuations and potential hypoglycemia risk.

Keywords: blood glucose; clinical pharmacist's intervention; consultation; glucose fluctuation; propensity score matching.

FIGURE 1

The flow diagram of the procedure of clinical pharmacist's consultation

FIGURE 2

The flow diagram of the selection process to determine eligible individuals. STEMI: ST‐segment elevation myocardial infarction; NSTEMI: non‐ST‐segment elevation myocardial infarction

FIGURE 3

Blood glucose and fluctuation data before and after pharmacist consultation. Blood glucose (A) before and after pharmacist consultation, which contains FBG, PBG, and BG. Glucose fluctuation (B) before and after pharmacist consultation, which contain SDBG, PBGE, and LAGE. Blood glucose data collected from blood glucose monitoring from fasting blood glucose (FBG, 6:00 am), post‐breakfast blood glucose (PBG,9:00 am), post‐lunch blood glucose (PBG,13:00 pm), and post‐dinner blood glucose (PBG,19:00 pm). Continuous data were collected 4 days before and 4 days after pharmacist consultation. BG, blood glucose; SDBG, standard deviation of blood glucose; PBGE, postprandial glucose excursion; LAGE, largest amplitude of glycemic excursions. Data were described as mean ± SE, p < .05 was considered as a significant difference. ^** p < .01 and ^* p < .05

FIGURE 4

Blood glucose and fluctuation data before and after propensity score matching (PSM). Blood glucose (A) and fluctuation (B) data before PSM and Blood glucose (C), and fluctuation(D) data after PSM. Blood glucose mainly contains FBG, PBG, and BG and blood fluctuation mainly contains SDBG, PBGE, and LAGE. Blood glucose data collected from blood glucose monitoring from fasting blood glucose (FBG, 6:00 am), post‐breakfast blood glucose (PBG, 9:00 am), post‐lunch blood glucose (PBG,13:00 pm), and post‐dinner blood glucose (PBG,19:00 pm). FBG data were collected 3 days before discharge and PBG data were collected 24 h before discharge and fluctuation data were calculated mainly based on 24 h before discharge. BG, blood glucose; LAGE, largest amplitude of glycemic excursions; PBGE, postprandial glucose excursion; SDBG, standard deviation of blood glucose. Data were described as mean ± SE, p < .05 was considered as a significant difference. ^** p < .01 and ^* p < .05