Helping Patients Manage Diabetes Burnout

When my daughter received a type 1 diabetes (T1D) diagnosis about 18 months ago, I could not even express how devastated I felt. I have been a pharmacist for about 20 years and even with my background, it was overwhelming. Managing diabetes is a constant job. Whether the patient has T1D or T2D, the condition can be very stressful. As I joined various online support groups, I noticed a lot of discussions about diabetes burnout.

The CDC acknowledges that diabetes burnout is real,¹ noting that “over time, the emotional burden of managing diabetes can cause burnout.” Drug Topics® interviewed several experts about how pharmacists can help patients or caregivers who are experiencing diabetes burnout.

Amanda Lane, MS, RD, LDN, CDCES

Amanda Lane, MS, RD, LDN, CDCES, is the founder of Healthful Lane Nutrition, LLC. “Diabetes distress or burnout can look different for everyone,” she said. “Some patients may be angry about their medications or checking [blood glucose]; others may brush it off with vague terms like ‘it’s all good,’ avoiding appointments, and not refilling medications on time.”

Stephanie Redmond, PharmD, CDCES, BC-ADM, cofounder and vice president of the Diabetes Doctor is a clinical pharmacist and diabetes educator. When ascertaining whether a patient has diabetes burnout, she looks for the following signs:

• The patient is not refilling prescriptions on time, indicating they are not taking medication.

• The patient does not bring in their meter, which is a sign they are not checking blood glucose as directed.

• The patient has not followed up in a long time or does not want to talk about their diabetes.

According to Lane, patients who need more medications or higher doses feel like they are doing something wrong. In these cases, “helping the patient or a caregiver learn how to fill a pillbox can be a super helpful way to combat diabetes distress,” she explained. “Seeing all the pill bottles multiple times per day can be overwhelming, but having a box that has the right medications portioned out can be less overwhelming.”

For certain patients, Lane recommends continuous glucose monitoring (CGM). However, she noted that first there should be a conversation about comfort level with new technology. “Some patients are more stressed by managing the increased technology that CGM requires, whereas others find the decreased finger sticks and increased glucose readings to be incredibly helpful,” she added.

Stephanie Redmond, PharmD, CDCES, BC-ADM

“Pharmacists are more involved than ever in CGM dispensing and education,” Redmond added.“ Wearing a CGM can have a huge real-time impact and teach lessons that checking blood glucose never can. [Patients can] see the benefits immediately of taking a medication, going on a walk, or eating nuts vs chips for a snack.”

Lane noted that Medicare covers CGM in patients meeting specific criteria. Those with T1D or T2D with multiple daily injections or other qualifying criteria can typically get CGM through their insurance. However, the insurance may dictate the brand of CGM that is covered.

Redmond suggested that pharmacists use motivational interviewing techniques, such as asking open- ended questions and giving the patient time to respond. “I love restating what they told me, to give them a chance to react in a positive way— [for example], ‘You feel like nothing you do helps your blood sugars.’ This gives the patient a chance to respond: ‘Well, when I walk on Saturday, I noticed Sundays are my best day,’” she explained.

Redmond also encouraged pharmacists to focus on the patient’s good blood glucose days, rather than the bad, and to brainstorm together on what makes the difference. “This helps encourage self-reflection,” she said.

Pharmacists can also give patients hope and encouragement. “They are not alone,” Redmond said. “It is helpful to find a support community— even online—of other individuals living with diabetes who have ideas or diet/exercise/lifestyle tips that have worked for them.” Pharmacists can remind patients to seek support—but not medical advice—from their peers.

Pharmacists should also help patients with a plan of action when they check blood glucose. “If you are checking blood [glucose] but not doing anything with that information, it really seems pointless to check,” Redmond noted. Pharmacists can ensure that the patient has a plan for how to treat highs and lows, as well as a glucagon prescription—and, crucially, knows how to use it and can train loved ones or caregivers to administer it during a hypoglycemic emergency.

Redmond tells her patients, “Focus on how to make your next decision a good one. Even if you ate chocolate cookies all day and feel like the day is wasted, you don’t have to commit to going to the gym for the next week or eating zero carbs. Just make your next decision, whether it’s dinner or a snack at bedtime, a healthier one. Or maybe it’s taking a 10-minute walk after dinner. One decision at a time seems easier than trying to undo a whole year’s worth of bad lifestyle habits. Small changes have a big impact in the end.”

Redmond also reminds pharmacists to counsel patients on their medications. “Often, patients take different medications for their diabetes and don’t understand why they would take more than 1. But if they understand that they work in different ways or have different benefits, they are more likely to take them,” she says.

She also offers information about adverse effects (AEs) and solutions, so patients know that certain AEs do not mean failure. “For example, metformin tells your liver to stop making so much [glucose] because you don’t need it. If you notice any loose stools, let me know; we can change to a long-acting tablet that can help, or reduce your dose. Your other medication, dapagliflozin [Farxiga], helps your kidneys urinate out extra [glucose] that the body doesn’t need. This means you are also losing calories, so it can help with weight loss. Most individuals notice an increase in urinary frequency for the first week or so, but this does get better with time.”

“When [a treatment plan] makes sense, patients want to take it and want to be healthier,” Redmond said.

Reference

1. Dealing with diabetes burnout. CDC. Updated January 26, 2022. Accessed June 20, 2022. https://www.cdc.gov/ diabetes/library/spotlights/diabetes-burnout.html