Focus on Pharmacy

Diabetes Prevention: Why Wait?

What do we know about preventing type 2 diabetes?

The progression from prediabetes to diabetes can be prevented with use of intensive lifestyle interventions as demonstrated in the Diabetes Prevention Program (DPP).

The Diabetes Prevention Program Outcomes Study (DPPOS) showed a 58% reduction in onset of type 2 diabetes, at 10 years this was slightly diminished to 34%. In the  Pathology and Reversibility of Prediabetes in a Biracial Cohort (PROP-ABC) study, 93% did not progress to diabetes and 43% returned to normal glucose regulation when intensive lifestyle interventions occurred shortly after a diagnosis of prediabetes (3 months to 8 years).

Current screening recommendations

The latest guidelines for screening are expected to identify a much larger population of people with diabetes and prediabetes than in previous years. This will present an opportunity to intervene at earlier stages in the progression of type 2 diabetes with proven strategies such the celebrated National Diabetes Prevention Program, Montana version. Both the American Diabetes Association (ADA) and the United States Preventative Services Task Force (USPSTF) have suggested screening guidelines.

USPSTF:

• Adults between the ages of 35 and 70 years with overweight or obesity
• Overweight, BMI 25 kg/m2 or greater, and obese 30 kg/m² or greater

ADA:

• At risk people of any age
• All adults at age 35 regardless of risk factors

Screening tests and prediabetes diagnostic values:

• Fasting Blood Sugar (FBS): 100-125 mg/dL
• A1c: 5.7-6.4%
• Oral glucose tolerance test: 140-199 mg/dL

Pharmacists are part of the solution

Diabetes Prevention Programs are within reach for most people in Montana who qualify. Programs are available either face to face or virtually, and are covered by Montana Medicaid, Medicare, and selected insurance companies. We have enough evidenced based information on diabetes prevention for pharmacists to be able to guide their patients in making prudent decisions. We just have to be proactive.

The 3-minute extra mile

Suggested pharmacist actions and talking points:

• Diabetes prevention programs can prevent the progression from prediabetes to diabetes and in some cases reverse prediabetes and return the person to normal glucose regulation.
• Encourage screening for patients over 35 or those at risk
• Go to the National Diabetes Prevention Program Montana site and find a program near you or one that offers virtual programs.
• Time is of the essence when a person is at risk for or already has prediabetes. The rapid introduction of intensive lifestyle intervention is paramount.
• Take advantage of the Montana Diabetes Program's Pharmacy Resources.
• Learn more about what your pharmacy can do, including offering a Diabetes Prevention Program. If you'd like to learn more or discuss options for your pharmacy please reach out.

James Bennett, BsPharm, CDCES, BCGP -Bozeman, MT

Asthma Disparities in Indigenous American Populations

A “health disparity” occurs when a health condition is found to be more prevalent in one group of people compared to another. Asthma is one such disparity seen in American Indian (AI) / Alaska Native (AN) populations that has been shaped by a variety of health, socioeconomic, and environmental factors.

Health Disparity Causes

Health disparities can have many causes, these are a few Montanans may be very familiar with:

• Lack of available health services- this is especially true in rural Montana, with our long distances
• Proximity to pollution
• Comorbidities- obesity, heart disease, and diabetes are among the most common.

• In 2019, approximately 14.0% of adult AI/AN Montanans reported having current asthma, compared to 9.5% seen in white, non-Hispanic Montanans.
• A national survey conducted in 2018 revealed that AI/AN adults were 20% more likely to have asthma.
• Nationally, the risk for asthma in AI/AN children was nearly double that compared to white, non-Hispanic children.
• In lower income Montana households, which make less than $25,000 per year, 13.1% of individuals reported having asthma compared to the highest income level which reported at 7.4%.
• A significantly higher percentage of adult Montanans with an elevated BMI currently have asthma compared to a normal or low BMI.

Current Resources

The National Asthma Control Program (NACP), a subset of The Centers for Disease Control and Prevention (CDC), developed the EXHALE strategic framework for healthcare professionals to help better control patient asthma. The six EXHALE strategies have been proven to reduce hospitalizations, emergency department visits, and health costs.

• Education on asthma self-management
• X-tinguishing smoke (+secondhand smoke) exposures
• Home visits to reduce triggers and provide education
• Achievement of guidelines-based asthma management
• Linkages and coordination of care across settings
• Environmental protocols to reduce indoor, outdoor, or occupational asthma triggers.

Pharmacist Action Steps:

• Advocate for public policy reform
• Provide education to improve asthma self-care
• Refer patients to community-based asthma programs
• Engage in asthma-based research opportunities if possible

Nathaniel Bennett, PharmD Candidate 2022 
Reviewed by Rachael Zins, PharmD, AE-C

Please share with colleagues and encourage them to Click to subscribe

For more information, contact: ChronicDiseasePrevention@mt.gov

1400 E Broadway
Helena, Montana 59620-2951
1-844-MTHLT4U (1-844-864-5848)
https://dphhs.mt.gov/publichealth/diabetes