Managing Metabolic Syndrome in Diabetes

Metabolic syndrome and diabetes are 2 of the most common diseases that pharmacists face in their daily practice. Because of this frequency, pharmacists play a vital role in reducing the burden for individuals living with these frequently comorbid conditions.

Phyllis Kamau, PharmD, a pharmacist with CVS Health, noted that the key for pharmacists working with patients who are dealing with metabolic syndrome and diabetes is to realize that patients frequently do not understand the relationship between the 2 conditions. Metabolic syndrome is characterized by abdominal obesity, high blood pressure, high blood sugar, elevated triglyceride levels, and low high-density lipoprotein cholesterol levels. A patient receives a diagnosis of metabolic syndrome if they meet 3 of these 5 criteria; having diabetes alone does not mean that the patient has metabolic syndrome—and vice versa. “There is a strong correlation, though, of having metabolic syndrome as a predictor of type 2 diabetes,” Kamau explained.

Michael P. Kane, PharmD, a professor at Albany College of Pharmacy and Health Sciences, noted that patients with metabolic syndrome typically have multiple comorbidities and therefore are taking several medications for multiple disease states. “It is important for patients to understand the importance of taking their medications as prescribed,” he said. “In addition, it is important for patients to know about appropriate lifestyle changes that can help [manage] these disease states. Patients need to be aware of potential adverse effects of medications and ways to mitigate or manage those [adverse] effects so that they can continue to better manage their diseases.”

And because patients often see the pharmacist monthly for medication refills—and therefore have access to their pharmacist more than their other health care providers—pharmacists are the best source of information regarding medications. This creates a wonderful environment for patient education and strategies to help Patients Better Manage Their Diseases.

Important Conversations

According to Joyce Y. Lee, PharmD, a health sciences clinical professor of pharmacy at UC Irvine School of Pharmacy & Pharmaceutical Sciences, patients with metabolic syndrome and diabetes are frequently experiencing challenges beyond medications. Therefore, in addition to optimizing the 4 Ds of medication management—drug safety, drug effectiveness, drug adherence, and dose titration—pharmacists must also focus on caring for patients as a whole, taking into account psychological and emotional needs, coaching individualized health behavior changes that last, and empowering patients’ self-care capabilities.

“Have an open-minded, nonjudgmental discussion with patients about their lifestyle and daily routines,” Lee said. “Emphasize the benefits of controlling metabolic syndrome and diabetes rather than the negative [aspects]. Point out areas that patients have done well in and areas that need further improvement. [Talk] with patients on strategies that have worked before and strategies that have not worked or are no longer working.”

Lee also recommended having patients propose a possible strategy to overcome the immediate problem. The pharmacist should provide suggestions and comment on the pros and cons of the strategy, modifying where needed to set a realistic timeline for strategy implementation.

Pharmacists should also be routinely screening patients’ profiles and recognize that most patients will be on medications for high blood sugar, blood pressure, and triglycerides—which is metabolic syndrome, although most patients will not know that. “Pharmacists should make it a point to counsel the patients on how lifestyle interventions could help to reverse these conditions, reducing their risk of cardiovascular disease and diabetes,” Kamau said. “The biggest challenge of counseling in retail is the time constraint. In most cases, there is not a lot of time for pharmacists to spend counseling a patient on how to manage their conditions. With a lot of intentionality, though, it can be done.”

Swathi Varanasi, PharmD, a pharmacy consultant in Los Angeles, California said one of the biggest challenges in the health care system is the overall unfamiliarity with getting to the root of the problem or thinking outside the box to solve a metabolic syndrome–related problem.

“This means asking probing questions with patience and understanding to figure out how to best help the patient improve their quality of life through not only their prescription medication regimen, but also their lifestyle,” she said. “An example is that the long-term use of metformin could lead to vitamin B₁₂ deficiency. If a patient who has been prescribed and is regularly taking metformin…complains of fatigue or poor memory, addressing a vitamin deficiency through supplementation could be very helpful.”

For patients who do not wish to take metformin, asking key questions regarding diet, exercise, stress, sleep, caffeine, and self-care could be integral to their improvement. It could also help them in weaning off medications after they have reached an ideal hemoglobin A_1c level.

“I have heard a lot of patients say that they were not aware of certain things when it comes to their health until the pharmacist mentioned it,” Kamau noted. “Pharmacists are able to recognize when the patients are not being [adherent to] their medications, and if they are incorrectly using or taking them.”

Lee feels it is also important to understand the health disparities in managing metabolic syndrome and diabetes among underserved populations.

“These patients’ challenges are often complicated by homelessness, mental illness, and poverty,” she explained. “Pharmacists are [in a] unique position to identify and look out for at-risk patients to ensure implementation of cost-effective therapies and access to eligible resources and technologies.”