Reducing the rates of diabetes across the United States

Abstract

The Association Report column in JAPhA reports on activities of APhA’s 3 Academies and topics of interest to members of those groups.The APhA Academy of Pharmacy Practice and Management (APhA--APPM) is dedicated to assisting members in enhancing the profession of pharmacy, improving medication use, and advancing patient care. Through the APhA--APPM Special Interest Groups (SIGs), the Academy provides members a mechanism to network and support the profession, by addressing emerging issues. To learn more about APhA–APPM and to access a listing of APhA--APPM SIGs, visit https://www.pharmacist.com/apha-academy-pharmacy-practice-and-management.The mission of the APhA Academy of Research and Science (APhA--APRS) is to stimulate the discovery, dissemination, and application of research to improve patient health. Academy members are a source of authoritative information on key scientific issues and work to advance the pharmaceutical sciences and improve the quality of pharmacy practice. Through the 3 APhA--APRS Sections (Clinical Sciences; Basic Pharmaceutical Sciences; and Economic, Social, and Administrative Sciences), the Academy provides a mechanism for experts in all areas of the pharmaceutical sciences to influence APhA’s policymaking process. To learn more about APhA--APRS, visit https://www.pharmacist.com/apha-academy-pharmaceutical-research-and-science.The mission of the APhA Academy of Student Pharmacists (APhA–ASP) is to be the collective voice of student pharmacists, to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy.The Association Report column is written by Officers and members of the respective Academy and coordinated by APhA staff. Suggestions for future content may be sent to Margaret Tomecki, Director, Practice and Science Academies ([email protected]). Over the last 2 decades, pharmacists’ role in diabetes care has evolved from being focused on medication use to a more patient-oriented approach through a lens of preventive health actions. Pharmacy services for diabetes care, particularly for type 2 diabetes, have varied from providing patients with diabetes education or medication management alone to a broader scope of public health. As a result, pharmacists are involved in various levels of diabetes prevention by leveraging partnerships with interdisciplinary stakeholders.1Ross L.W. Bana F. Blacher R.J. et al.Continuous stakeholder engagement: expanding the role of pharmacists in prevention of type 2 diabetes through the National Diabetes Prevention Program.Prev Chronic Dis. 2020; 17: 190374Crossref Google Scholar The Association Report column in JAPhA reports on activities of APhA’s 3 Academies and topics of interest to members of those groups. The APhA Academy of Pharmacy Practice and Management (APhA--APPM) is dedicated to assisting members in enhancing the profession of pharmacy, improving medication use, and advancing patient care. Through the APhA--APPM Special Interest Groups (SIGs), the Academy provides members a mechanism to network and support the profession, by addressing emerging issues. To learn more about APhA–APPM and to access a listing of APhA--APPM SIGs, visit https://www.pharmacist.com/apha-academy-pharmacy-practice-and-management. The mission of the APhA Academy of Research and Science (APhA--APRS) is to stimulate the discovery, dissemination, and application of research to improve patient health. Academy members are a source of authoritative information on key scientific issues and work to advance the pharmaceutical sciences and improve the quality of pharmacy practice. Through the 3 APhA--APRS Sections (Clinical Sciences; Basic Pharmaceutical Sciences; and Economic, Social, and Administrative Sciences), the Academy provides a mechanism for experts in all areas of the pharmaceutical sciences to influence APhA’s policymaking process. To learn more about APhA--APRS, visit https://www.pharmacist.com/apha-academy-pharmaceutical-research-and-science. The mission of the APhA Academy of Student Pharmacists (APhA–ASP) is to be the collective voice of student pharmacists, to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy. The Association Report column is written by Officers and members of the respective Academy and coordinated by APhA staff. Suggestions for future content may be sent to Margaret Tomecki, Director, Practice and Science Academies ([email protected]). Studies report that the integration of pharmacists into diabetes prevention programs (DPPs) helps prevent the occurrence of diabetes, detect diabetes complications, and delay the deterioration of diabetes-related complications and death.2Hudspeth B.D. Power of prevention: the pharmacist's role in prediabetes management.Diabetes Spectr. 2018; 31: 320-323Crossref PubMed Scopus (5) Google Scholar The impacts of these DPPs include improved patient knowledge of diabetes and its treatment, better shared decision-making between patients and providers regarding diabetes self-care, and improved patient diabetes management skills. Pharmacists are the third largest group of health professionals and are well positioned to provide preventive health services because of their convenient locations and extended hours of operation. To delay and prevent diabetes, pharmacists engage in primary diabetes prevention by providing educational interventions to increase the awareness of the importance of a healthy lifestyle. Moin et al.3Moin T. Duru O.K. Turk N. et al.Effectiveness of shared decision-making for diabetes prevention: 12-month results from the prediabetes informed decision and education (PRIDE) trial.J Gen Intern Med. 2019; 34: 2652-2659Crossref PubMed Scopus (23) Google Scholar examined the effectiveness of DPPs and found that pharmacist-led shared decision-making using decision aids as intervention tools led to increased engagement in the DPP and weight loss for adults with prediabetes who were overweight. In national DPPs, pharmacists partner with other health professionals to promote the awareness of prediabetes among people at risk for diabetes.4Centers for Disease Control and PreventionRx for the National Diabetes Prevention Program: Action Guide for Community Pharmacists. Centers for Disease Control and Prevention, United States department of Health and Human Services, Atlanta, GA2019Google Scholar Given the frequency of patient encounters in pharmacies each day, coupled with pharmacists’ access to clinical information for risk assessment, pharmacists are in a prime position to educate at-risk patients about prediabetes and how making modest lifestyle changes could improve their health. To prepare student pharmacists to facilitate DPPs, some pharmacy schools have focused on linking their existing curriculum to a broader scope in diabetes prevention. Doing this equips student pharmacists with the essential skills needed to serve as lifestyle coaches. In a recent study, Woodard et al.5Woodard L.J. McKennon S. Danielson J. Knuth J. Odegard P. An elective course to train student pharmacists to deliver a community-based group diabetes prevention program.Am J Pharm Educ. 2016; 80: 106Crossref PubMed Google Scholar tailored an existing diabetes prevention class for student pharmacists that highlighted knowledge of prediabetes risk and evidence-based communication skills. The results showed that this led to the students’ increased confidence in their ability to deliver DPPs in a group setting. In addition to promoting patients’ awareness of diabetes, increasing relevant knowledge of diabetes among those at risk, and educating patients about a healthy lifestyle, pharmacists have engaged in secondary diabetes prevention through screening people at risk for diabetes and preventing the complications of diabetes. Gamston et al.6Gamston C.E. Kirby A.N. Hansen R.A. et al.Description of a pharmacist-led diabetes prevention service within an employer-based wellness program.J Am Pharm Assoc (2003). 2019; 59: 736-741Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar implemented a pharmacist-led diabetes prevention service to university employees by using opportunistic glycated hemoglobin (HbA1c) screening. Of the 740 individuals recruited in their study, more than 10% of the participants were identified with either prediabetes-level or diabetes-level HbA1c. Recommendations were made for the incorporation of opportunistic HbA1c-level testing in pharmacist-led wellness programs.6Gamston C.E. Kirby A.N. Hansen R.A. et al.Description of a pharmacist-led diabetes prevention service within an employer-based wellness program.J Am Pharm Assoc (2003). 2019; 59: 736-741Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Pharmacists in national DPPs offer risk assessment and blood glucose–level testing to identify patients who are at high risk of developing type 2 diabetes and then refer these patients to primary care physicians for further care.4Centers for Disease Control and PreventionRx for the National Diabetes Prevention Program: Action Guide for Community Pharmacists. Centers for Disease Control and Prevention, United States department of Health and Human Services, Atlanta, GA2019Google Scholar A systematic review on pharmacists’ input in metabolic screening showed that the key to successful patient care lies in the inclusion of pharmacists in a multidisciplinary team with a streamlined process for screening and referring patients to timely health care access.7Al AdAwi R.M. Stewart D. Ryan C. Tonna A.P. A systematic review of pharmacist input to metabolic syndrome screening, management and prevention.Int J Clin Pharm. 2020; 42: 995-1015Crossref PubMed Scopus (4) Google Scholar As such, pharmacists are well positioned as part of the public health task force to aid secondary diabetes prevention by providing screening and referral services. Several systematic reviews have examined the impact of pharmacist interventions on the economic, clinical, and humanistic well-being of people with diabetes through tertiary diabetes prevention.10Santschi V. Chiolero A. Paradis G. Colosimo A.L. Burnand B. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials.Diabetes Care. 2012; 35: 2706-2717Crossref PubMed Scopus (113) Google Scholar, 11Presley B. Groot W. Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: a systematic review and meta-analysis.Res Social Adm Pharm. 2019; 15: 1057-1067Crossref PubMed Scopus (49) Google Scholar, 12Mirhoseiny S. Geelvink T. Martin S. Vollmar H.C. Stock S. Redaelli M. Does task delegation to non-physician health professionals improve quality of diabetes care? Results of a scoping review.PLoS One. 2019; 14e0223159Crossref PubMed Scopus (4) Google Scholar, 13Nogueira M. Otuyama L.J. Rocha P.A. Pinto V.B. Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials.Einstein (Sao Paulo). 2020; 18eRW4686Crossref PubMed Scopus (12) Google Scholar, 8Wubben D.P. Vivian E.M. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review.Pharmacotherapy. 2008; 28: 421-436Crossref PubMed Scopus (205) Google Scholar, 9Bukhsh A. Tan X.Y. Chan K.G. Lee L.H. Goh B.H. Khan T.M. Effectiveness of pharmacist-led educational interventions on self-care activities and glycemic control of type 2 diabetes patients: a systematic review and meta-analysis.Patient Prefer Adherence. 2018; 12: 2457-2474Crossref PubMed Scopus (15) Google Scholar To ameliorate the progression of diabetes and its complications, pharmacists have used educational and behavioral approaches to provide self-management education on the disease and medications, counseling, and medication review.11Presley B. Groot W. Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: a systematic review and meta-analysis.Res Social Adm Pharm. 2019; 15: 1057-1067Crossref PubMed Scopus (49) Google Scholar In addition, pharmacists have collaborated with other health professionals to provide diabetes care through medication management, feedback to physicians, measurement of cardiovascular risk factors, and referral of patients to other diabetes educators.10Santschi V. Chiolero A. Paradis G. Colosimo A.L. Burnand B. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials.Diabetes Care. 2012; 35: 2706-2717Crossref PubMed Scopus (113) Google Scholar Nogueira et al.13Nogueira M. Otuyama L.J. Rocha P.A. Pinto V.B. Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials.Einstein (Sao Paulo). 2020; 18eRW4686Crossref PubMed Scopus (12) Google Scholar reviewed 15 randomized clinical trials (RCTs) to investigate the impact of pharmacists’ interventions on the clinical outcomes of people with type 2 diabetes and found that they effectively reduced participants’ HbA1c and triglyceride levels as well as systolic blood pressure, and increased high-density lipoprotein levels. Bukhsh et al.9Bukhsh A. Tan X.Y. Chan K.G. Lee L.H. Goh B.H. Khan T.M. Effectiveness of pharmacist-led educational interventions on self-care activities and glycemic control of type 2 diabetes patients: a systematic review and meta-analysis.Patient Prefer Adherence. 2018; 12: 2457-2474Crossref PubMed Scopus (15) Google Scholar conducted a meta-analysis of 11 RCTs and concluded that pharmacist-led diabetes interventions demonstrated a significant, positive effect on the self-monitoring of blood glucose, foot care, and overall diet. Furthermore, pharmacist-led interventions of diabetes care were associated with high patient satisfaction12Mirhoseiny S. Geelvink T. Martin S. Vollmar H.C. Stock S. Redaelli M. Does task delegation to non-physician health professionals improve quality of diabetes care? Results of a scoping review.PLoS One. 2019; 14e0223159Crossref PubMed Scopus (4) Google Scholar and cost-savings in diabetes care.14Wang Y. Yeo Q.Q. Ko Y. Economic evaluations of pharmacist-managed services in people with diabetes mellitus: a systematic review.Diabet Med. 2016; 33: 421-427Crossref PubMed Scopus (43) Google Scholar In summary, pharmacist-managed services in the tertiary prevention of diabetes have shown a positive return in economic viability and improvement in patient satisfaction and health outcomes. Although ample studies have shed light on the value of pharmacists’ services at different tiers of diabetes prevention, we are unable to identify which intervention is most effective and beneficial to patients with diabetes. Prior literature points out that the lack of rigorous and theory-based study designs makes it difficult to determine the true effect of interventions and best practices for diabetes care. More recent research has adopted theoretical frameworks to identify pertinent elements for intervention development.15Bailey S.C. Brega A.G. Crutchfield T.M. et al.Update on health literacy and diabetes.Diabetes Educ. 2014; 40: 581-604Crossref PubMed Scopus (167) Google Scholar Informed by behavioral theories, researchers have expounded on other factors that may influence patients’ knowledge, attitude, and behavior regarding diabetes care and self-management.15Bailey S.C. Brega A.G. Crutchfield T.M. et al.Update on health literacy and diabetes.Diabetes Educ. 2014; 40: 581-604Crossref PubMed Scopus (167) Google Scholar Salient psychosocial factors, including health literacy, self-efficacy, patient-provider communication, and social support should be systematically addressed when implementing diabetes interventions.16Huang Y.M. Pecanac K.E. Shiyanbola O.O. "Why am I not taking medications?" Barriers and facilitators of diabetes medication adherence across different health literacy levels [e-pub ahead of print]. Qual Health Res.https://doi.org/10.1177/1049732320945296Date accessed: October 8, 2020Google Scholar, 17Shiyanbola O.O. Unni E. Huang Y.M. Lanier C. The association of health literacy with illness perceptions, medication beliefs, and medication adherence among individuals with type 2 diabetes.Res Social Adm Pharm. 2018; 14: 824-830Crossref PubMed Scopus (35) Google Scholar, 18Rao D. Maurer M. Meyer J. Zhang J. Shiyanbola O.O. Medication adherence changes in Blacks with diabetes: a mixed methods study.Am J Health Behav. 2020; 44: 257-270Crossref PubMed Scopus (8) Google Scholar Integrating longitudinal study designs and multicomponent interventions with a duration of at least 6 months is recommended to assess sustainable intervention effects. In addition, conducting theoretically informed RCTs that incorporate rigorous mixed-methods methodological techniques is recommended to guide pharmacy practice with solid evidence.19Norman G. Westby M.J. Vedhara K. Game F. Cullum N.A. Effectiveness of psychosocial interventions for the prevention and treatment of foot ulcers in people with diabetes: a systematic review.Diabet Med. 2020; 37: 1256-1265Crossref PubMed Scopus (9) Google Scholar It is evident that patients with diabetes benefit from the involvement of pharmacists in various aspects of diabetes care. Pharmacists who directly engage with patients to provide guidance on disease monitoring, lifestyle modification, and medication use, as well as regular follow-up support, achieve better patient diabetes outcomes. Collaboration with other health care stakeholders for diabetes care can provide improved care for patients with diabetes. As well, pharmacists should continue to document their services and publish their results and research findings to enrich the existing knowledge of pharmacy practice in diabetes care.HuangView Large Image Figure ViewerDownload Hi-res image Download (PPT) Olayinka O. Shiyanbola, PhD, BPharm, Associate Professor, Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, WI Yen-Ming Huang, PhD, MS, BPharm, Assistant Professor, Department of Allied and Population Health, College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD