Implementing Patient Education Strategies to Help Patients in Reducing or Preventing the Incidence of Prediabetes, Type 2 Diabetes

^{By: Yvette C. Terrie, RPh, BS Pharm, Consultant Pharmacist, Medical Writer}

As frontline health care providers, pharmacists are in a pivotal position to act as patient identifiers, patient educators and patient advocates especially for those at risk for or with diabetes. They can also utilize patient counseling techniques as a means to augment awareness among their patients about the soaring rates of type 2 diabetes and the escalating number of individuals at risk for prediabetes. According to the CDC, an estimated 88 million ( representing 1 in 3 individuals)  in the U.S. have prediabetes and even more alarmingly more than 84% of those individuals are not even aware that they are at risk. ¹ The American Diabetes Association indicates that up to 70% of individuals with prediabetes will eventually develop diabetes.²  Additionally, the most recent CDC statistics report that more than 34 million Americans have diabetes (representing about 1 in 10 individuals), and nearly 90-95% of them have type 2 diabetes.² Type 2 diabetes (T2DM) frequently manifest in individuals over age 45, but more and more pediatric patients, teens, and young adults are also developing T2DM due to the growing obesity rates in our country.³ According to a recent publication in JAMA, between 2011 and 2016, there has been a substantial increase in the prevalence of metabolic syndrome which is linked to CVD, T2DM and all-cause mortality in those ages 20-39 years with the greatest increases found among females.⁴ According to a recent survey from the American Heart Association (AHA) and the American Diabetes Association (ADA), 7 in 10 survey participants worried that poor health will affect their ability to live life the way they would like.⁵ The survey indicated that respondents with T2DM, CVD or stroke were more concerned especially since the start of the pandemic that poor health will limit their experiences (89%, 90% and 87%, respectively) compared to respondents who don't have those conditions (58%).⁵

Ideally, identifying, diagnosing, and treating diabetes early on is crucial since clinical interventions may reduce or prevent diabetes related complications, but according to the ADA, unfortunately T2DM is commonly not diagnosed until complications have occurred.  For a patient newly diagnosed with prediabetes or T2DM, the diagnosis is often overwhelming for many patients, but the good news is that through patient education, pharmacists can ease patient fears and concerns via routine monitoring, patient counseling and ensuring that patients understand the importance of tight glycemic control, following the recommended treatment plan especially adherence to medication and diet plan when applicable and understanding their individual risk factors.  According to the ADA, routine self-monitoring of blood glucose is an integral component of diabetes care. Pharmacists can also be instrumental in informing patients about the evolving landscape of diabetes medications that are available and make clinical recommendations when warranted to optimize clinical outcomes. Pharmacists can also direct patients to the various patient cost savings programs that are sponsored by some manufacturers to make medications more affordable. They can also remind patients that sometimes their primary health care provider may need to make therapy changes when necessary to help them meet the recommended target goals for blood glucose levels and that they should not get discouraged if treatment plan changes are necessary. 

 During patient counseling, pharmacists can inform patients  that suboptimal management of diabetes including lack of patient adherence and not monitoring blood glucose levels or adhering to dietary recommendations can raise risk of diabetes related health complications including microvascular and macrovascular complications.

As frontline health care providers, pharmacists should seize every possible opportunity to educate patients about prediabetes and diabetes and encourage those at risk for or diagnosed with prediabetes or diabetes to take an active role in their own health care and discuss any concerns with their primary health care provider. According to the American Pharmaceutical Association, one study reported that pharmacist-directed medication therapy management aids in enhancing the health of diabetic patients. The study revealed that those patients with sub-optimally controlled T2DM who sought pharmacists’ involvement in their care had increased medication adherence and better glycemic control than those without a pharmacist's involvement. ⁶ Numerous other studies report the positive impact of pharmacists in diabetic care. Diabetes is a complex, progressive and often challenging condition that requires patients to take an ongoing and active role in the management of this disease. Patient commitment and patient motivation to care are fundamental parts of achieving successful clinical outcomes. As pharmacists, we can encourage and help patients set realistic goals, direct them to the various diabetes education resources and empower and educate our patients with pertinent health information that will enable them to make informed decisions about their overall health and live productive and fulfilling lives.

Yvette C. Terrie, RPh, Consultant Pharmacist and Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com/).

References:

1. Prediabetes - Your Chance to Prevent Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/prediabetes.html . Published June 11, 2020. Accessed July 15, 2020.
2. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2020
3. American Diabetes Association. Diabetes Care Jan 2020, 43 (Supplement 1) S32-S36; DOI: 10.2337/dc20-S003 .
4. Type 2 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type2.html . Published May 30, 2019. Accessed July 15, 2020.
5. Hirode G, Wong RJ. Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016. JAMA. 2020;323(24):2526–2528. doi:10.1001/jama.2020.4501.
6. HeartNews. Survey: 7 in 10 respondents worry poor health will limit their life experiences. EurekAlert website. https://www.eurekalert.org/pub_releases/2020-07/aha-s7i070720.php . Published July 7, 2020. Accessed July 22, 2020.
7. Skinner JS, Poe B, Hopper R, Boyer A, Wilkins CH. Assessing the effectiveness of pharmacist- directed medication therapy management in improving diabetes outcomes in patients with poorly controlled diabetes. The Diabetes Educator. 2015;41(4):459-465. doi:10.1177/0145721715587563