Evaluation of Diabetes Education and Pharmacist Interventions in a Rural, Primary Care Setting.

Abstract

Diabetes affects 29.1 million Americans, or 9.3% of the U.S. population, and is associated with significant costs to the health care system (1). The estimated total cost of diabetes increased from $132 billion in 2002 to $245 billion in 2012. Average medical expenditures are 2.3 times higher in patients with diabetes compared to those without diabetes (1). Diabetes self-management education (DSME) is the ongoing process of facilitating the knowledge, skills, and ability necessary for diabetes self-care (2). Patients with diabetes make multiple decisions every day about their health management. The literature supports the effectiveness of diabetes education to improve clinical outcomes and quality of life in this complicated patient population (3). General practice providers have limited time to spend with patients for diabetes education (4). To overcome this barrier, an interprofessional approach to care has been used to give patients the tools they need to achieve glycemic targets. Because of their medication expertise in a variety of chronic disease states, pharmacists are well positioned to provide comprehensive diabetes services, including basic education and counseling on diabetes topics such as blood glucose management, diet, and exercise. Pharmacists also have the ability to monitor patients’ laboratory testing values and to recommend therapies for hypertension, dyslipidemia, cardiovascular disease, and microvascular complications, which are often seen with advanced diabetes (5). Diabetes regimens have become more involved as multiple new therapies have become available within the past several years (6). Patient counseling is imperative regarding new medications such as glucagon-like peptide-1 (GLP-1) receptor agonists, sodium–glucose cotransporter 2 inhibitors, and concentrated insulins. With multidrug regimens that include new agents, the risk of adverse effects and hypoglycemia increases. Pharmacists can draw on their training and expertise to improve both clinical and economic outcomes related to diabetes medications (5). Because of the versatility of …