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Joan Vos MacDonald is a freelance writer living in upstate New York.
The pharmacist’s role in diabetes management is more important than ever before, given the number of patients with diabetes and the number of options available for treating them.
The most effective way to manage a patient’s diabetes, according to the American Diabetes Association (ADA), is with a team-based approach-and that team may be most effective if it includes a pharmacist. A 2018 study, published in the Journal of Managed Care and Specialty Pharmacy, found that adding pharmacists to diabetes care teams not only improves patient outcomes, but can help prevent complications and reduce costs.1
“Whether it’s a member of the rounding team in the hospital or a member of the patient-centered medical home team in the ambulatory care setting, pharmacists are an integral part of the team that cares for each patient,” Sarah L. Anderson, PharmD, FCCP, BCPS, BCACP, associate professor at the University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, said. “Being present allows pharmacists to voice their recommendations and educate the medical team on the evidence that supports it.”
As part of a team, pharmacists can help guide treatment decisions.
“With the ever-growing armamentarium of diabetes medications, pharmacists play a huge role in helping select medications that maximize efficacy, minimize side effects, benefit other concurrent disease states (eg, kidney or cardiovascular disease), and minimize costs,” Anderson said. “The ADA algorithm for treatment of diabetes is somewhat of a ‘choose your own adventure’ path, and pharmacists are key for helping both patients and providers choose the right medication(s) for the patient’s individual situation.”
Knowing how the health system’s formulary works means pharmacists are in a position to help contain costs while still recommending guideline-based medication therapy.
“Pharmacists have a keen understanding of balancing not only benefit versus risk when recommending a medication, but also whether the medication is cost-effective,” Anderson said.
Pharmacists also play an important role in medication adherence, which is more likely when patients know what the medication is expected to do, how to take it, what adverse effects (AEs) to possibly expect, and whether those AEs may be temporary.
“Health system pharmacists help to encourage medication adherence by discussing each patient’s medications with them so that the patient is educated on why they are prescribed each medication,” Anderson said.
It’s easy for a patient to feel overwhelmed when diagnosed with diabetes, since the diagnosis often requires learning how to administer insulin, monitor insulin levels, and make lifestyle changes. A patient may benefit from access to a health system pharmacist who can answer questions, help set up glucose monitors, and make practical recommendations.
“Pharmacists can also help with recommending and assisting the patient in obtaining a pill box and educating the patient on apps or use of alarms on their phones to assist with medication reminders,” Anderson said.
In a hospital setting, clinical pharmacists help monitor patients’ A1C blood sugar levels and markers for other conditions, such as high cholesterol and high blood pressure. Their help can also make it easier for patients to leave the hospital after treatment.
“Pharmacists in the hospital are also great bridges to pharmacists in the ambulatory and community settings and can assist in ‘warm handoffs’ to ensure seamless transitions, as the patient transitions from the hospital back to the ambulatory setting,” Anderson said.
A recent report by the CDC estimates that more than 100 million US adults are now living with diabetes or prediabetes. Diabetes is the seventh leading cause of death in the United States and places individuals at an increased risk of health complications such as vision loss, heart disease, stroke, and kidney failure, as well as amputation of toes, feet, or legs.2
“The pharmacist’s role in diabetes management is more important than ever before given the number of patients with diabetes and the number of options available for treating them,” Anderson said.
As more new diabetes medications come to market, health system pharmacists can aid in the decision-making process to ensure that the medication is necessary and cost-effective.
“Newer doesn’t necessarily always mean better,” Anderson said. “Pharmacists can help with cost containment by stepping in with an alternate recommendation if that which is recommended is expensive yet yields little benefit to the patient.”
1. Benedict AW, Spence MM, Sie JL, et al. Evaluation of a pharmacist-managed diabetes program in a primary care setting within an integrated health care system. Journal of Managed Care & Specialty Pharmacy. Published February 24, 2018. https://doi.org/10.18553/jmcp.2018.24.2.114
2. New CDC report: More than 100 million Americans have diabetes or prediabetes [news release]. CDC’s website. https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html.