Optimizing Treatment Strategies for Diabetes - Episode 5
Key opinion leaders share strategies to effectively educate patients on diabetes.
Jerry Meece, RPh, CDCES, FACA, FADCES: If your patients are like mine, they come to you with a lot of questions about what they’ve heard. This is what I know about diabetes: I know how to control diabetes. Just don’t eat anything white. All these are great suggestions. But how do you educate your patients on the risk of acute hypoglycemia and chronic hyperglycemia, such as the microvascular and macrovascular complications? How do you educate patients? What are your best thoughts on going forward with that?
Jennifer D. Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP: Jerry, what’s most critical is exactly what you just said: education. Avoiding hypoglycemia means making sure patients are educated to prevent it from happening, but they need to be prepared in case it happens. That’s what’s most important. If they’re taking medications that can cause hypoglycemia, such as insulin, that increases their risk of hypoglycemia. We need to make sure they understand the signs, the symptoms, how to prevent it from happening, and how to manage it if it does happen. It needs to be high priority. That would be choosing drinks or foods or glucose for recovery or to bring their blood sugars up. Access to glucagon is critical.
Pharmacists are in a perfect place. They’re filling prescriptions in the community. Even if they’re inpatient, upon discharge in a hospital, if somebody is getting a prescription for insulin, they’re in a position to make sure patients go home with glucagon. Get an order for glucagon. We now have such better options for glucagon for an emergency than those kits. Remember the kits with all those steps and you had to reconstitute it?
Jerry Meece, RPh, CDCES, FACA, FADCES: Yes.
Jennifer D. Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP: Now we have glucagon autoinjectors and even nasal [spray] available. For acute hypoglycemia and avoidance, we’re in a perfect place to take care of that, so we need to do that. Hyperglycemia in terms of microvascular and macrovascular complications is also an important part of their education. Diabetes doesn’t have to be a death sentence. We need to talk about preventing both. You’ll probably recognize this number: in the UKPDS [United Kingdom Prospective Diabetes] trial, with every 1% decrease in the A1C [glycated hemoglobin], there was a 37% reduction in microvascular complications. That’s powerful information. Patients care about that. If you’re going to talk about their eyes, kidneys, and feet, with every 1% decrease, you decrease the risk of microvascular problems by 37%. That’s important.
The other thing we and patients care about is macrovascular complications. Nonfatal MIs [myocardial infarctions], nonfatal strokes, or death due to a cardiovascular event is important to them. We need to make sure they understand that they’re at an increased risk of major adverse cardiovascular events, in addition to drug therapy, glycemic control, and choosing drugs that are beneficial in those types of situations: lifestyle changes, lipid control, and blood pressure control. All these are supported by the American Diabetes Association guidelines.
Jerry Meece, RPh, CDCES, FACA, FADCES: Right. When we’re talking to patients, we get so carried away, saying, “We need to get your A1C from 9% down to 7.5%.” They look at us and say, “I’m not that interested in getting from 9% to 7.5%. What’s the point?” But then you put it exactly as you said, “If we can drop your A1C by 1%, all the studies are showing that we can decrease the chance of blindness and kidney disease by 37%. If we can go from 10% to 8%, we’ve decreased the risk of you developing these complications that you think are always going to happen. We can cut them in half.” Put it in those terms. “This is why we want you to inject on time. Take these medications at the right time because there’s a definite correlation between better management and reduced complications.” I don’t think we emphasize that enough.
Transcript edited for clarity.