The medical compliance record of the nation's 18 million Type 2 diabetes patients is bleak. Two-thirds don't have their glucose levels under control, putting them at high risk for blindness, kidney failure, foot and leg amputations, and heart disease, according to the American Association of Clinical Endocrinologists (AACE). "It's horrible," said Paul Jellinger, M.D., immediate past president of the American College of Endocrinology. "Health professionals need to aggressively help their patients learn how to manage their disease."
Many of the nation's 134,000 community pharmacists would like to help lower the number of noncompliant patients, according to reports such as the California HealthCare Foundation's recent The Role of Community Pharmacists in Diabetes Care. "Millions of Americans with diabetes could benefit from the clinical skills of their community pharmacists and the accessibility of their local pharmacists," said the report. "This is the premise behind programs enabling community pharmacists to help diabetes patients maintain their health."
Self-management for diabetes patients focuses on tight control of blood sugar, through diet and exercise alone or with medication. The best measure of control is glycosylated hemoglobin (A1c), a way of tracking average blood-sugar levels over two or three months. Endocrinologists define glucose control as an A1c level below 6.5%. According to their data, 67% of Type 2 diabetes patients are not meeting that goal.
Bluml and his colleagues recently studied the effectiveness of the Patient Self-Management Program (PSMP) for Diabetes, a credentialing process developed by the APhA Foundation and Aventis Pharmaceuticals that teaches pharmacists how to help diabetes patients control their glucose levels. They looked at a one-year PSMP pilot project sold to self-insured employers through regional pharmacy
networks, such as the Piedmont Pharmaceutical Care Network in North Carolina-a network of qualified clinical pharmacists located throughout North Carolina who provide services such as medication reviews and targeted drug therapy management with a common goal of improving patient outcomes-and Kroger Pharmacists in Ohio. The pilot study included 80 community pharmacists with PSMP training in Greensboro and Wilson, N.C.; Dublin, Ga.; Manitowoc County, Wis.; and Columbus, Ohio. The pharmacists provided diabetes care services to 256 patients covered by self-insured employers' health plans.