Impact of SMART Goals on Diabetes Management in a Pharmacist-Led Telehealth Clinic

Background: Although there is evidence demonstrating successful implementation of SMART (specific, measurable, achievable, relevant, time-bound) goals in clinical settings, their impact on improving diabetes control has not been well-established. Objective: The primary objective was to determine the association between setting SMART goals and change in A1c among a Veteran population. Methods: This was an IRB-approved retrospective, case-control study. Patients with Type 2 diabetes mellitus (DM) managed virtually by a Clinical Pharmacy Specialist at a VA Community-Based Outpatient Clinic were eligible for inclusion. The electronic medical record was used to identify patients that set a SMART goal for DM management during the study timeframe. These patients were matched to a similar cohort of patients that did not set a SMART goal. Results: There were 100 patients included in the study. Goal A1c was achieved in 30% of patients in the SMART goal group compared with 24% of patients in the control group. There was a 1.2% reduction in A1c from baseline to 3 months in the SMART goal group vs .85% in the control group (P = .287). The mean number of medication changes per patient was 1.7 in the SMART goal group vs 2.1 in the control group (P = .174). Patients in the SMART goal group set an average of 1.5 SMART goals during the study period. Conclusion: Overall, patients that set SMART goals had clinically meaningful A1c lowering. Setting SMART goals for DM management in agreeable patients during diabetes telehealth visits may lead to fewer medication changes and improved diabetes control.