Jerry Meece, RPh, CDCES, FACA, FADCES: If your patients are anything like mine, they come to you with a lot of questions about what they’ve heard. This is what I know about diabetes: I know how to control diabetes. Just don’t eat anything white. These are all great suggestions. But how do you educate your patients about the risk of acute hypoglycemia and chronic hyperglycemia, including microvascular and macrovascular complications? How are patients educated? What are your best thoughts about moving forward with that?
Jennifer D. Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP: Jerry, the most critical thing is exactly what you just said: education. Avoiding hypoglycemia means making sure patients are informed to prevent it from happening, but they must be prepared in case it does happen. That is the most important. If they are taking medications that can cause hypoglycemia, such as insulin, that increases the risk of hypoglycemia. We need to make sure they understand the signs, the symptoms, how to prevent it from happening, and how to manage it if it does happen. It has to be high priority. That would be choosing drinks, food or glucose for recovery or to raise blood sugar. Access to glucagon is essential.
Pharmacists are in a perfect place. They are filling prescriptions in the community. Even if they’re inpatients, when they’re discharged from a hospital, if somebody gets a prescription for insulin, they’re in a position to make sure the patients go home with glucagon. Get an order for glucagon. We now have better glucagon options for an emergency than those kits. Remember the kits with all those steps and you had to reconstitute it?
Jerry Meece, RPh, CDCES, FACA, FADCES: Yes.
Jennifer D. Goldman, RPh, PharmD, CDCES, BC-ADM, FCCP: Now we have glucagon autoinjectors and even nasal [spray] available. For acute hypoglycemia and avoidance, we’re in a perfect place to take care of that, so we need to. Hyperglycemia in terms of microvascular and macrovascular complications is also an important part of their education. Diabetes does not have to be a death sentence. We need to talk about preventing both. You will probably recognize this number: on the UKPDS [United Kingdom Prospective Diabetes] test, with each 1% decrease in A1C [glycated hemoglobin], there was a 37% reduction in microvascular complications. That is powerful information. Patients worry about it. If you’re going to talk about their eyes, kidneys, and feet, with every 1% decrease, you decrease your risk of microvascular problems by 37%. That is important.
The other thing that concerns us and the patients is macrovascular complications. non-fatal MI [myocardial infarctions], non-fatal strokes or death due to a cardiovascular event is important to them. We need to make sure they understand that they are at increased risk of major adverse cardiovascular events, in addition to drug therapy, glycemic control, and choosing drugs that are beneficial in those types of situations: lifestyle changes, of lipids and changes in the blood. pressure check. All of these are supported by the American Diabetes Association guidelines.
Jerry Meece, RPh, CDCES, FACA, FADCES: Right. When we talk to patients, we get carried away and say, “We need to get your A1C down from 9% to 7.5%.” They look at us and say, “I’m not that interested in going from 9% to 7.5%. What’s the point of?” But then he phrases it exactly as he said: “If we can lower your A1C by 1%, all the studies show we can reduce the chance of blindness and kidney disease by 37%. If we can go from 10% to 8%, we’ve lowered the risk of you developing these complications that you think are always going to happen. We can cut them in half. Put it in those terms. “That’s why we want you to inject on time. Take these medications at the right time because there is a clear correlation between better handling and fewer complications.” I think we don’t emphasize that enough.
Transcript edited for clarity.