ASHP 08: Pharmacists debate diabetes testing, pharmacy education

How best to help and test diabetes patients and which degrees should be required of pharmacy students were among the hot topics discussed at the Clinical Specialists and Scientists Networking-Primary Care and Pharmacotherapy Session.

Some of the pharmacy directors at the session agreed that the hemoglobin A1c blood glucose tests for diabetes patients should be tailored to each patient's life situation.

"An 8% A1c is good for some of the folks we serve, while for others, it is 6.5%," said Stephen Setter, PharmD, DVM, assistant professor of pharmacotherapy with Washington State University in Spokane, who moderated the networking session with the audience. Setter added, "The ones [providers] I get frustrated with are those who require testing a couple times a week, even though nothing has changed with the patient's exercise and food."However, Will Elliott, clinical coordinator and residency director at the Veterans Administration Medical Center in Fayetteville, North Carolina, said the majority of the type 2 patients that the facility serves require insulin and monitoring is recommended. "We recommend testing two to three times a week for the type 2 patients. I don't think anyone would argue with regulating blood sugar," Elliott said.

At the same time, patient education is key. "I ask those patients, ‘If you are testing three times a day, what are you doing as a response to those blood sugars?' " Elliott said.

Whether or not patients with type 2 diabetes should be allowed to monitor their own glucose levels was also an issue of controversy.

"There is a controversy about whether patients with type 2 diabetes benefit from monitoring their blood glucose. Self-monitoring is beneficial for patients using insulin, but it has not yet proven beneficial for patients on other diabetes medications," Setter said.

Is a PharmD degree sufficient?
Pharmacists and others at the networking session also debated whether the PharmD degree is sufficient for pharmacy school graduates to begin working in the field, or whether residency training should be required.

Pharmacy and clinical directors in the audience agreed that residency and practical experience helps in some cases, but PharmD training is enough for some students.

"The level of training differs very much from one school to the next. Just because you have graduated and have your degree does not necessarily make you a good clinical practitioner," Elliott said.

"I would prefer someone who has been out in the industry 23 years, rather than the PharmD who just graduated. I would rather have people with fewer initials and more practical experience," Setter said.