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Optimizing Treatment Strategies for Diabetes - Episode 1

The Increasing Prevalence of Diabetes

Jerry Meece, RPh, CDCES, FACA, FADCES, initiates a discussion around the increasing prevalence of patients diagnosed with diabetes.

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Jerry Meece, RPh, CDCES, FACA, FADCES: Hello, and welcome to another Drug Topics® In-Depth Pharmacy Insights [titled “Optimizing Treatment Strategies for Diabetes”]. We’ll discuss how pharmacists can interact with people with diabetes to improve outcomes and improve their quality of life. We’ll also cover some of the tools and techniques pharmacists can use in their practice to better communicate with and educate people with diabetes.

My name is Jerry Meece, and I’ll be serving as your moderator for this webcast. I’m a pharmacist, a certified diabetes care and education specialist, and the director of clinical services at Plaza Pharmacy and Wellness Center in Gainesville, Texas. With me is Dr Jennifer Goldman, a professor of pharmacy practice at the Massachusetts College of Pharmacy [and Health Sciences] in Boston, Massachusetts, and a clinical pharmacist in certified diabetes care and an education specialist at Well Life Medical in Peabody, Massachusetts. She’s been practicing for over 30 years and has numerous publications in the areas of diabetes and cardiovascular disease.

With such meaty subject matter to cover, let’s get started. I’m going to dive right in. I’m going to throw you a tough question right off the bat. With the prevalence of diabetes and prediabetes in this country increasing—the last count was just north of 37 million people with diabetes and 96 million people with prediabetes—what are some of the ways pharmacists can educate patients on reducing the risk of developing type 2 diabetes?

Jennifer D. Goldman, PharmD, RPh, CDCES, BC-ADM, FCCP: We all need to consider and think about lifestyle changes. Pharmacists are in a great position to talk about good foods, smaller portion sizes, being less sedentary, exercising regularly, weight loss, and drinking water instead of sugary drinks. That’s a good place to start for pharmacists to discuss prevention.

Jerry Meece, RPh, CDCES, FACA, FADCES: What you hit on is what we’re looking at with our audience: how do we deliver these messages in short bursts? Sometimes 3 to 5 minutes. You and I are lucky. In our practice, we get to sit down for 30 or 45 minutes or an hour with a patient and go over things in detail. Sometimes our pharmacists don’t have that. So on this theme, how do we deliver these messages in short, concise bursts with our patients?

You brought up something that sounds like it’s from the Diabetes Prevention Program [DPP]. We can incorporate those aspects. I bet your patients are like mine. They come into the clinic and say, “I’m really motivated. I’m going to drop 50 lb. I’m going to ride my stationary bike, which I just ordered off Amazon, 5 miles a day. I’m going to put all that together, and I’m going to get all this done in the next month.” Sometimes we have to reel that back in and help patients understand that attainable goals could be something like losing 5% to 7% of our weight, maybe 10 to 12 lb, and operating that stationary bike for 30 min, 5 days a week—150 min a week—because the DPP showed that works so well. They reduced diabetes incidence by 58% doing that, and even better in the older population. If everybody gets too crazy when they start these things out, the stationary bikes end up as coat racks in the back bedroom. We want patients using them on a daily basis.

Our stories, between you and me, go back many years. There was once a young Native American girl in my pharmacy. She came in with her mother. Her mother had poorly managed diabetes for many years. It resulted in severe neuropathy in her hands and feet, and severe retinopathy, almost leading to blindness. We were trying to get her under better management. At one point, this young girl stepped out of the room with me and asked, “Is that me in 20 years?” I got a chance to sit down with her. I said, “No, this doesn’t have to be you. As a Native American, you’re at higher risk, but you’re a young track star. You’re getting out there, and you have a thin frame. At this point, if you can continue that exercise and make sure you get all that in and concentrate on eating healthier, this doesn’t have to happen to you.” The story that pharmacists can bring to their customers is that this doesn’t have to occur. Diabetes doesn’t have to occur, even if it’s prevalent in your family.

Transcript edited for clarity.

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