Educating Diabetes Patients About Heart Disease

Cardiovascular disease is the leading cause of death for people with diabetes. Pharmacists are ideally suited to help educate patients with diabetes and to raise their awareness of how risk factors for cardiovascular disease can be controlled. More and better education for these patients about risk factors, lifestyle changes, and medication regimens can help reduce mortality and the financial burden on the healthcare system.

Evan Sisson“Pharmacists overall are doing a better job and are much more aware of what it takes to properly counsel a [diabetes] patient than they were probably even ten years ago,” said Jerry Meece, RPh, CDE, FAADE, FACA, director of clinical services at Plaza Pharmacy and Wellness Center in Gainesville, TX. “We are the first person to see the patient after he or she gets a prescription for a medication.”

“We know that people with diabetes have twice the risk of having heart disease as their peers of the same age who do not have diabetes,” said Evan Sisson, PharmD, CDE, FAADE, a spokesperson for the American Association of Diabetes Educators and an Associate Professor at Virginia Commonwealth University School of Pharmacy in Richmond. “We are the small part of the funnel often times for patients who have multiple providers. We have a better sense, across the spectrum of a patient’s illnesses, of what is going on with them,” Sisson added.

Because of this positioning, pharmacists have opportunities to ask diabetes patients the right questions and give them the right information in a productive way, which can help them meet their goals, said Meece. But there are often gaps in education for these patients because of time constraints on pharmacists, he added. “As a result, the job doesn’t get done as well as it should.”

In some cases, diabetes and cardiovascular disease education for these patients is being done by pharmacists who are also certified diabetes educators (CDEs). There are 19,316 CDEs, of whom 1,295 are pharmacists, said Tommy Johnson, PharmD, CDE, of Clinton, SC. Johnson is the chair of the Board of Directors of the National Certification Board for Diabetes Educators, located in Arlington Heights, IL. The majority of CDEs are nurses, but there are also physician, physician assistant, dietician, and exercise physiologist CDEs.

“Usually, in an overview of diabetes we talk about controlling the ABCs: the A1_c, the blood pressure, and the cholesterol,” said Johnson. “Eighty percent of people with type 2 diabetes die of heart attacks and strokes-- and that is what we are trying to prevent.”

There is no one particular area of treating cardiovascular disease or any one class of medications to which pharmacists should pay special attention for their diabetic patients, said Meece. Getting the patient to understand the need to adhere to his or her medications may be the bigger problem. There are so many complex and expensive medications available that are wasted if the patient does not take them correctly, he noted. A little extra time spent by the pharmacist to explain the importance of a drug like a statin can help that person understand what the medicine is for and why he needs to keep taking it.

But of course a pharmacist does not need to be a CDE to help patients understand the strong link between diabetes and cardiovascular disease, Meece noted. By asking a few questions, the pharmacist can open a constructive dialog with a patient, he added. Motivational interviewing skills-asking questions and discussing issues in ways that do not put the person on the defensive-can be key to helping patients maintain blood glucose levels and stay adherent with their medications.   

“There are good data to show that only half of those people who are prescribed cholesterol lowering medicine are still taking their statin at the end of a year,” Sisson said. If a pharmacist notes that a patient is not refilling his cholesterol or hypertension medications, it could be time to ask if there are problems that keep that person from taking them. Pharmacists can start a conversation about the risks of heart disease in these situations. “They can ask, ‘What is the hardest thing about taking this medicine or what would have to change for you to get this filled on time?’” he said.

Even in a busy community pharmacy, short conversations can help, Johnson said. A pharmacist can pick a few diabetes patients each day who will be coming in to pick up their prescriptions and ask to review their glucose log books. . . or ask to check their blood pressure. . . or to see the cholesterol levels from their most current lab to look for the effectiveness of the therapy as well as to emphasize adherence to medication and lifestyle changes, he said. “This is something that pharmacists can do proactively.”

“When a pharmacist receives a prescription for hypertension or high cholesterol or diabetes, that should be a flag,” Sisson said. These three disorders tend to aggregate and if a patient is being treated for one disease, the pharmacist should view him as if he is being treated for the other two, he explained.

Although reimbursement for the time spent counseling an individual patient with diabetes may be very limited, accredited diabetes educational programs for patients can be reimbursed, Sisson said. The AADE accredits such programs, which must include a CDE. This is one reason that more pharmacists are seeking certification, he said. An accredited program can include other healthcare professionals, such as dietitians and podiatrists as a team.

Johnson recommends that pharmacists pursue certification. The CDE designation signifies to other healthcare providers that the pharmacist is especially knowledgeable about how best to educate people about their diabetes.

There is more information about diabetes education and certification as a diabetes educator at the websites of the American Association of Diabetes Educators website (https://www.diabeteseducator.org/) and the National Certification Board for Diabetes Educators (http://www.ncbde.org/).

Valerie DeBenedette is a medical news writer in Putnam County, N.Y.