The Importance of Pharmacists in Care Teams for Pregnant People with Diabetes


A Q&A with Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP, director of education and training in diabetes technology at the Cleveland Clinic.

The prevalence of diabetes in pregnant individuals has been increasing across the world and a rise in gestational diabetes has also been observed. Diabetes in pregnant individuals can pose a risk to both maternal and fetal health, including complications like spontaneous abortion, fetal anomalies, preeclampsia, neonatal hypoglycemia, and neonatal respiratory distress syndrome.1 This is why having a multidisciplinary care team for pregnant individuals is of vital importance, and pharmacists are often some of the most important members of those teams.

Drug Topics sat down with Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP, director of education and training in diabetes technology at the Cleveland Clinic, to discuss the importance of multidisciplinary care teams for pregnant patients with diabetes, why pharmacists are crucial members of those teams, and how pharmacists can help address specific challenges that pregnant people with diabetes might experience.

Drug Topics: Can you talk about the importance of a multidisciplinary care team for patients with diabetes in pregnancy? Why are pharmacists such crucial members of this team?

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP: I think that managing diabetes and pregnancy is a lot of work. There's the dietary and the healthy eating components of it. There's the impacts of physical activity, the glucose monitoring, and then the impacts of insulin, and insulin is a drug with a very narrow therapeutic window. Many things impact it, like the timing or the type of food that it's taken with, the impact from the fat and the protein. By having different team members, like having the dietician on the team, working with maternal fetal medicine and having endocrinology really helps.

I think, especially, the role of the pharmacist having expertise about medications like insulin can really help to further get glucose levels to goal and we can work with people to adjust those doses to really help them reach those pregnancy targets which are really intensive. It is a lot of work. That's why we need a team because we have these super intensive targets and it's also a finite amount of time, right? Pregnancy is a limited amount of time. We all kind of work harder to achieve these targets and we can do that much better with a team versus somebody working by themselves.

Drug Topics: What are some specific challenges that pregnant people with diabetes might experience, and how can a pharmacist address those specific challenges?

Isaacs: Well, many. Our drug of choice in pregnancy is insulin. For gestational diabetes, like that would be diabetes that's diagnosed typically during the pregnancy like weeks 24 to 28, many will, some are diet control, but many will go on to require insulin. Then other types, like those that had preexisting type 2 diabetes, often are going to require insulin throughout their pregnancy. Of course, every person with type 1 will continue to need insulin throughout their pregnancy.

I think pharmacists are really in an ideal position to help to manage that. Many of us have a collaborative practice agreement that allows us to prescribe medications, adjust medication doses, and often we are more accessible. In pregnancy, we actually titrate doses every week. That's a lot. That's like a lot of visits, a lot of appointments. In terms of access, a lot of people don't have that kind of access, but often we're able to facilitate that. That's one of the things I do in my practice. I have these weekly visits, check ins, to adjust the insulin doses.

1. ElSayed NA, Aleppo G, Aroda VR, et al. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S254-S266. doi:10.2337/dc23-S015
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