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Pharmacist Intervention for Safer Prescribing in Patients With Type 2 Diabetes at High Risk: A Randomized Clinical
Lisa K Gilliam1, Melissa M Parker2, Minnie W Chen1
1The Permanente Medical Group, South San Francisco Kaiser Medical Center, South San Francisco, California.
JAMA Network Open
|February 18, 2026
Summary
Clinical pharmacist outreach significantly improved diabetes medication safety for high-risk patients with type 2 diabetes (T2D), reducing hypoglycemia events without worsening glycemic control. This proactive approach enhances patient safety.
Area of Science:
- Clinical Pharmacy
- Diabetes Management
- Patient Safety
Background:
- Severe hypoglycemia is a dangerous complication of diabetes medications, increasing risks of falls, cardiovascular events, cognitive decline, and mortality.
- Identifying and mitigating hypoglycemia risk in patients with type 2 diabetes (T2D) is crucial for improving patient outcomes and reducing healthcare burdens.
Purpose of the Study:
- To evaluate the effectiveness of proactive clinical pharmacist outreach using an evidence-based hypoglycemia-prevention algorithm in promoting safer diabetes prescribing.
- To determine if this intervention reduces the risk of severe hypoglycemia in high-risk T2D patients.
Main Methods:
- A randomized clinical trial involving 200 adults with T2D at high risk for hypoglycemia.
- Participants were randomized to either a clinical pharmacist outreach intervention group or a usual care control group.
- The primary outcome measured was the proportion of patients prescribed safer diabetes regimens, defined by the discontinuation of sulfonylureas and/or specific insulin types.
Main Results:
- Patients in the intervention arm were significantly more likely to be prescribed safer diabetes regimens compared to the control arm (28.1% vs. 15.8%).
- The intervention group experienced fewer hypoglycemia-related emergency department or inpatient encounters (0 vs. 5.3%).
- No significant worsening of hemoglobin A1c (HbA1c) control was observed in the intervention arm.
Conclusions:
- Proactive, protocol-driven clinical pharmacist outreach integrated into team-based care improves medication optimization and patient safety in T2D management.
- This evidence-based strategy effectively reduces the risk of severe hypoglycemia in high-risk individuals, enhancing overall patient well-being.
- The intervention shows potential for reducing healthcare costs associated with hypoglycemia-related events.
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