Pharmacists role

1
Pharmacists role

• in Diabetes Mellitus

2
Pharmacists role

• The pharmacists role in the primary prevention
  of diabetes
• The pharmacists role in detecting undiagnosed
  diabetes
• The pharmacists role in the prevention of
  complications
• Referral criteria
• Quality standards
• Questionnaire for People with Diabetes
• Summary of revised WHO Diagnostic Criteria for
  Diabetes

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The pharmacists role in the primary
prevention of diabetes

• Opportunistically promote a healthy lifestyle
• Factors such as obesity and lack of physical
  activity have been strongly linked with the
  incidence of Type 2 diabetes and the rising world
  prevalence of Type 2 diabetes is mainly
  attributed to lifestyle changes. The modern diet
  of fast foods and high calorie drinks is not
  helpful. The prevention of obesity in children
  and young adults is particularly important. In
  addition, cardiovascular disease is a major cause
  of premature death in people with diabetes. Try
  to maximize your use of information material. You
  can obtain leaflets and posters from your local
  health promotion unit, pharmaceutical companies,
  Diabetes UK and other sources, e.g. the British
  Heart Foundation. Promotion of a healthy
  lifestyle is of course important at all stages of
  the disease process, whether it be primary
  prevention of diabetes or secondary prevention of
  complications. The importance of regular eye
  examinations should also be promoted.

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The pharmacists role in detecting
undiagnosed diabetes

• Those who may be at risk include Over 40
  years of age Relatives of people with Type 2
  diabetes People with hypertension
  People with hyperlipidaemia People
  with history of myocardial infarction Women
  who have had gestational diabetes Obese or
  non-active and people of SE Asian/African
  Caribbean origin

• The symptoms Thirst and a dry mouth
  Passing large amounts of urine. Incontinence
  TirednessWeight loss Genital itching
  blurred vision. If you suspect that a patient
  may have undiagnosed diabetes you should refer
  them to their GP. N.B. Revised diagnostic
  criteria for diabetes issued in 2000 by the World
  Health Organization (WHO) Monitor OTC sales
• This offers a very important opportunity. When
  .responding to symptoms. or to requests for OTC
  products for cystitis, vaginal thrush,
  persistent cutaneous infections e.g. boils,
  styes, skin chafing under the breast, athletes
  foot and other fungal infections, maintain a high
  index of suspicion for diabetes, particularly if
  the condition is recurrent

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The pharmacists role in the prevention
of complications

• At presentation of the first prescription
• a. Confirm they have diabetes (in case of
  prescription error) and establish yourself as a
  source of information on diabetes care.
• You must know where to find the information or be
  able to direct the patient to the most
  appropriate source
• b. The management of prescribed medicines is a
  specific role for pharmacists and so it is
  particularly important that we fulfill this role.
  On receipt of the prescription, check the dosage
  regime and assess the prescription for any drug
  interactions.

• At presentation of a repeat prescription a.
  Check for Anomalies in the prescription
• b. Hand out a short questionnairec. Remind,
  clarify information and educate patients in a
  graduated manner . General health promotion
  Diabetes cared. Check on progresse. Special
  situationse.1 Dealing with teenagers and young
  adults e.2 Diabetes and minor illness
• Monitoring
• a. A source of monitoring equipmentb. Check
  patients monitoringc. Meter testingd.
  Encourage patients to keep appointments for
  check-upsRelated services
• a. Offer a smoking cessation service and/or link
  into new smoking cessation services being set up
  locallyb. Get involved in local medicines
  management projects

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Referral criteria

• Community pharmacists should refer people with
  diabetes to an appropriate professional.Areas
  requiring referral includeFoot problems Poor
  glycaemic control Blurred visionWomen with
  diabetes who are planning a pregnancy or who have
  had a recent positive pregnancy test (if not
  already seen by a doctor)Drug addicts
  Patients with concerns you cannot deal with.

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Quality assurance

• It is essential to periodically review the
  service you provide to people with diabetes.
  The benefit of review is that it provides
  yourself other health professionals and other
  bodies
• Ways undertaking a review include Talking to
  other health professionals involved in the care
  of people with diabetes to see what their
  opinions of your service are talking to people
  with diabetes their carers.
• Monitoring your activity by recording
  team-related enquiries and referrals to other
  members of the  Diabetes All interventions and
  their outcomes The uptake of leaflets

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Questionnaire for People with Diabetes

• In our pharmacy we aim to provide a high quality
  service for people with diabetes and to work with
  the other members of the diabetes team to ensure
  that you receive a good standard of care. In
  order to help us with this, we would be grateful
  if you could take the time to answer a few
  questions about yourself and your diabetes. Your
  responses will be treated in strict confidence.
  About Yourself
• How old are you ? What are your living
  circumstances ?How long have you had
  diabetes?Which of the following people have you
  seen about your diabetes ?
• Yes No Dont know
• My GP, My hospital specialist, diabetes nurse, a
  Dietitian, chiropodist, optometrist .Education
  is a very important part of diabetes care

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Summary of revised WHO Diagnostic Criteria for
Diabetes

• Summary of changes
• The World Health Organization has published
  revised Definition, Diagnosis and Classification
  of Diabetes Mellitus and its Complications, and
  Diabetes UK has recommended that all healthcare
  professionals adopt the new criteria from 1 June,
  2000. The main changes of the new recommendations
  are set out below. They include the
  recommendation that the cut off point for
  diagnosing diabetes using a fasting plasma
  glucose should be lowered from 7.8 mmol/l to 7.0
  mmol/l. This change reflects research evidence
  regarding the development of the complications of
  diabetes.
• Methods and criteria for diagnosing diabetes
  mellitus
• . Diabetes symptoms (ie polyuria, polydipsia and
  unexplained weight loss) plus
• a random venous plasma glucose concentration
  11.1 mmol/l
• or a fasting plasma glucose concentration 7.0
  mmol/l. (Whole blood 6.1mmol/lor 2 hour plasma
  glucose concentration 11.1 mmol/l 2 hours after
  75g anhydrous glucose in an oral glucose
  tolerance test (OGTT )
• . With no symptoms diagnosis should not be based
  on a single glucose determination but requires
  confirmatory plasma venous determination. At
  least one additional glucose test result on
  another day with a value in the diabetic range is
  essential, either fasting, from a random sample
  or from the two hour post glucose load. If the
  fasting or random values are not diagnostic the
  2-hour value should be usedClassification and
  terminology
• ? The terms Type 1 and Type 2 will replace IDDM
  and NIDDM, and Type 1 and Type 2 process will be
  introduced to describe the cause of
  insulindependent and non-insulin dependent
  diabetes respectively.
• ? Impaired Glucose Tolerance (IGT) is a stage of
  impaired glucose regulation (Fasting plasma
  glucose lt 7.0 mmol/ and OGTT 2-hour value
  7.8mmol/l but lt 11.1 mmol/l).
• ? Impaired Fasting Glycaemia (IFG) has been
  introduced to classify individuals who have
  fasting glucose values above the normal range but
  below those diagnostic of diabetes. (Fasting
  plasma glucose 6.1 mmol/l but lt 7.0 mmol/l).
  Obviously some concern has been expressed about
  the implications of these changes for diabetes
  care. The new criteria have simplified the
  diagnosis of diabetes and the ability to diagnose
  cardiovascular high risk cases in many people.
  Earlier diagnosis will increase the total number
  of people with diabetes, but if they are managed
  according to Diabetes UK guidelines, many of
  these new cases will be diet controlled. In the
  long term, complications should be lessened to
  the benefit of the individual and to the health
  service. IGT and IFG are not clinical entities
  in their own right, but rather risk categories
  for cardiovascular disease (IGT) and/or future
  diabetes.(IFG

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The End

• This information is related to Practice
  Guidance for Community Pharmacists on the Care of
  People with Diabetes ( second edition
  )Published by the Royal Pharmaceutical Society
  of Great Britain