How pharmacists can reinforce good diabetes management

The International Diabetes Center at Park Nicollet Institute in Minneapolis recently released the findings of two surveys it sponsored in collaboration with Amylin Pharmaceuticals and Eli Lilly. Harris Interactive conducted the on-line surveys of 636 U.S. adults aged 18 and over with Type 2 diabetes and 409 U.S. primary care physicians who see at least one patient with Type 2 diabetes per month. The survey results highlight the disconnect between patients' goals and their actions and the gaps in communication between patients and their physicians.

Although 98% of patients said that diet and exercise are important in managing their diabetes, only 15% claimed they follow a prescribed diet plan "all or most of the time," and only 9% said they exercise "all or most of the time."

According to 91% of the physicians surveyed, getting their patients to adhere to a diet and exercise regimen is the biggest challenge they face in helping patients manage their disease. Almost all (99%) of the physicians surveyed said their typical patient with Type 2 diabetes is given a target A

_1C

goal, but 37% of patients said that they never discussed a target level with their physician.

Physicians estimated that an average of 94% of their patients get an A

_1C

test done regularly—every three to six months. However, only 79% of patients reported that they had their level checked within the past six months.

More than 80% of physicians said they often brought changing the prescribed diabetes regimen to their patients. However, 37% of patients said that changing their management plan was never discussed.

Interestingly, 87% of physicians said that their patients were afraid of needles, while only 36% of patients expressed this fear. Given these findings, it makes sense that 40% of patients said they wish their healthcare providers would listen to them more often.

Such gaps in patient-provider communication are not surprising, said Stuart Haines, Pharm.D., BC-ADM, BCPS, a professor at the University of Maryland School of Pharmacy in Baltimore and a clinical specialist at the Joslin Diabetes Center at the University of Maryland Medical Center. "Like many of us, healthcare practitioners tend to overestimate how good a job they are doing, until or unless they see actual data," he contended. He noted, however, that the opposite is also true. Many patients do not recall conversations they may have had with their provider about their A

_1C

level, for example. So the truth often lies somewhere between the two.

"Pharmacists can reinforce the message about good glycemic, blood pressure [BP], and cholesterol control and emphasize to patients what those numbers should be," Haines said. "They can also encourage patients to ask about their test results at every physician office visit and record those numbers in a log."

Haines went on to say that the Visit Planning Tool from the American Diabetes Association can help patients keep track of their test results. "Patients can record their A

_1C

, blood pressure, and medications in this pocket-size booklet. They can also record other health behaviors that they should be engaging in."
Although it is not currently available on-line, the Visit Planning Tool is available free of charge by calling (800) DIABETES. Haines suggested that pharmacists write down patients' medications for them or even obtain copies of the booklet and distribute them to patients.

Haines noted that the National Diabetes Education Program (NDEP), a federally funded program sponsored by the National Institutes of Health and the Centers for Disease Control & Prevention, has resources for healthcare professionals. He specifically mentioned "Working Together to Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental Professionals." This particular set of resources includes a primer, a patient education poster suitable for hanging in the pharmacy, and a diabetes medication reference booklet.

The NDEP offers many different patient education materials, many of which are available in both English and Spanish. Haines pointed out that a few pamphlets and flyers are available in less universally known languages as Korean, Japanese, and Vietnamese.

All of the NDEP materials can be downloaded free of charge at: