Diabetes
Pharmacists & National Diabetes Awareness Month: Our Opportunity to Step UP
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National Diabetes Awareness Month is recognized each November by several national organizations. Each focuses on specific areas of the diabetes universe and offers downloadable promotional and educational materials on their websites. |
- American Diabetes Association (ADA): Taking The Big Step Up against diabetes. Encouraging awareness, detection, management, and learning to thrive with diabetes.
- Association of Diabetes Care and Education Specialists (ADCES): National Diabetes Education Week. Looking at the ADCES7 Health-Care Behaviors and highlighting the value of diabetes care and education specialists in helping people manage diabetes and prediabetes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Small Steps Make a Big Difference, focusing on pre-diabetes and preventing diabetes with a downloadable tool-kit available on the website.
- Juvenile Diabetes Research Foundation (JDRF): Movers and Shakers, Type1 Diabetes Changemakers, and inspiring stories about people with Type1 Diabetes.
This is a good time for pharmacists to take our own Big Step Up and devote some extra attention to people with diabetes. Here are some ideas, all of which are achievable action items for pharmacists in most practice settings. The links at the end of each section will take you to information sources or patient handouts. |
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Advocate for diabetes prevention. Defined as either an A1c value from 5.7% to 6.4%, a fasting blood glucose of 100mg/dL to 125 mg/dL, or a 2-hour oral glucose tolerance value between 140 mg/dL and 199 mg/dL. The National Diabetes Prevention Program showed that structured lifestyle interventions can reduce the progression from pre-diabetes to diabetes by 58%. Find a program in your area and refer those in need. MT Diabetes Programs
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Screen people at risk for pre-diabetes. One in 10 adults in the United States has diabetes, one in five with diabetes don’t know they have it, and one in three adults in the United States has pre-diabetes. There is a simple test that can tell a person if they are at risk for type-2 diabetes. MT Risk Test
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Encourage statins for cardiovascular disease risk reduction. People with diabetes or prediabetes are at high risk for cardiovascular complications. Adults with diabetes between the ages of 40 and 75 should be taking a statin of at least moderate intensity, if tolerated. Statin Patient Handout
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Talk to your patients with diabetes about Chronic Kidney Disease (CKD). Estimated to occur in a third of patients with diabetes, the majority are unaware they have of this condition. They should be tested at regular intervals and encourage patients to know their numbers. Current guidelines recommend both the estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR) as preferred tests. CKD Patient Handout
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Teach self-monitored blood pressure (SMBP). Since most people with type-2 diabetes also have hypertension, the ADA recommends every person with diabetes utilize SMBP. Make sure you have a selection of validated devices and know how to instruct patients on their use. AMA Validated BP Device List.
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Discuss eye health. Diabetic retinopathy is a microvascular complication of poorly controlled diabetes and one of the leading causes of blindness. Pharmacists should talk to their patients about routine comprehensive eye examinations by a qualified professional. ADA Diabetic Retinopathy
James Bennett BsPharm, CDCES, BCGP
Bozeman MT
Asthma
Single Maintenance and Reliever Therapy
Could the SABA inhaler be replaced as the hallmark treatment of asthma exacerbations? The new SMART, Single Maintenance and Reliever Therapy, may have the data to support this change.
SMART involves the patient taking the same medication used for asthma control when they would regularly use a SABA during an asthma exacerbation. This SMART therapy has been studied using ICS-formoterol inhalers, with budesonide being the primary ICS. Formoterol has a similar onset of action to albuterol (approximately 2-3 minutes) but its effects persist for about 12 hours. The maintenance dose of ICS-formoterol is often two inhalations twice daily, but the maximum dosing of formoterol allows for up to 12 puffs in one day.
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When compared head-to-head, patients on SMART regimens had lower relative risk for asthma exacerbations, lower rates of oral corticosteroid use/hospitalizations, and less nighttime awakenings than patients on a SABA alone. There was no increase in the documented number of harms between the two groups.
Overuse of SABA inhalers can lead to saturation of beta receptors. When beta receptors become saturated the patient no longer receives relief from their bronchodilator and during an asthma emergency this can be life threatening. Saturation of beta receptors is why LABAs are not prescribed independently of inhaled corticosteroids in patients with asthma. ICS up regulate the lung's beta receptors preventing over-saturation. When a combination ICS-LABA is used for symptom relief, the patient always receives corticosteroid with their bronchodilator.
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Pharmacist Actions:
- Pharmacists should monitor for patients filling more than two rescue inhalers per year and consider a discussion on asthma control and maintenance therapy. SABA overuse, defined as greater than two albuterol canisters per year, is associated with greater risks of asthma exacerbation and mortality.
- For patients whose asthma is well controlled with an ICS-LABA and as needed SABA, switching to SMART is not indicated. For patients whose asthma is not well controlled on an ICS-LABA and as needed SABA, SMART therapy should be considered before moving up in step therapy.
Keegan Whelan, PharmD Candidate, approved by Rachael Zins, Pharm D, AE-C
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