R. Ph.s can identify patients at risk of diabetes

November 8, 2004

As healthcare professionals, we are all painfully aware of the increase in the incidence of diabetes in our nation. We are also aware that there are many people in our midst who don't realize they have diabetes. The American Diabetes Association (ADA) estimates that the disease affects over 18 million Americans, with 5.2 million of those cases going undetected. As the most visible and accessible health provider in the community, the pharmacist has a unique opportunity to help stanch the spread of diabetes in our country. Therefore, our objective is to have community pharmacies increase their frequency of random glucose screenings in order to identify patients who are at elevated risk for diabetes or may have the disease and not know it. Pharmacists should also be prepared to provide education not only on the treatment but also the prevention of diabetes.

With this in mind, several pharmacies in the greater Kansas City area and the University of Missouri Kansas City (UMKC) School of Pharmacy recently combined efforts to conduct diabetes screenings throughout the metropolitan area and outlying communities. Advertising was completed through radio, local newspapers, and store flyers for the one-day event. The screenings were offered free of charge and were completed at a variety of locations, including 12 Medicine Shoppe Pharmacies; Countryside Pharmacy in Savannah, Mo.; Wilkinson Pharmacy in Nevada, Mo.; Good Neighbor Pharmacy in Lexington, Mo.; and eight Hen House grocery store pharmacies. Through these settings we were able to reach a random sample of the population in each community. We feel that having so many stores in such a diverse market area enabled us to reach many of the ethnic and socioeconomic areas that Kansas City and surrounding communities have to offer. The weather was cooperative and did not affect the flow of patients through the chosen settings.

Screenings were conducted by UMKC pharmacy students using TheraSense and Ascensia glucose monitors. All students were instructed on the proper technique for testing with each type of monitor. Testing at each site was under the supervision of the pharmacist, and students were instructed to inform the pharmacist of any abnormal readings. Patients with high readings were then referred to their primary care provider for follow-up. Abnormal readings were categorized according to the following ADA guidelines. Fasting readings were divided into <100mg/dL; 100-125mg/dL; and 126mg/dL. Similarly, nonfasting readings were divided into <140mg/dL; 140-199mg/dL; and 200mg/dL. Both sets of data reflect normal, prediabetic, and diabetic readings, respectively, as shown in Table 1.

Based upon our study, 69 (15.8%) of the nondiagnosed patients had abnormal blood glucose readings; 50 (11.5%) were classified as prediabetic, while 19 (4.3%) were in the diabetic range. These data certainly substantiate the fact that many individuals may be living with undetected diabetes. Our responsibility as healthcare professionals is to continue to do as many screenings as possible in order to identify at-risk patients and refer them to their primary care provider. Early diagnosis has many advantages, including improved quality of life, de-creased lifetime healthcare costs, increased life expectancy, and greater family and community awareness of this medical condition.