Cardiovascular disease (CVD) is considered to be one of the major complications associated with diabetes and the leading cause of morbidity and mortality among diabetic patients.¹ Death due to CVD or stroke affects at least 65% of individuals with diabetes.^1,2 Furthermore, when compared with nondiabetics, adults with diabetes have two-to fourfold higher rates of CVD, because many individuals with type 2 diabetes have increased rates of hypertension, obesity, and dyslipidemia.² Fifty percent of patients have evidence of CVD at the time they are diagnosed with type 2 diabetes.³ Statistics indicate that 97% of adults with type 2 diabetes have ≥1 lipid abnormalities, and ~70% of diabetics have some degree of hypertension.¹

With effective patient education and counseling, patients with diabetes can obtain the information necessary to implement strategies to successfully manage their condition. Thus, they can reduce or prevent the progression of CV complications, as well as the other complications associated with uncontrolled diabetes.

Increasing Awareness

Because pharmacists typically are characterized as among the most accessible health care professionals, they are in a pivotal position to increase awareness of diabetes and to educate diabeties about the importance of managing their disease. An excellent counseling tool to employ when advising patients about diabetes and CVD risks was developed by the National Diabetes Education Program. It is commonly referred to as Be Smart About Your Heart: Control the ABCs of Diabetes. This mnemonic device enables patients to easily remember the key components for optimal management of their diabetes (Table).^1,4

Another initiative to raise awareness about the connection between diabetes and CVD is a collaborative effort between the American Diabetes Association (ADA) and the American College of Cardiology. This initiative is known as Make the Link! Diabetes, Heart Disease and Stroke.⁵ This program provides pertinent information for both patients and health care professionals about reducing CV risks.

Most recently, in June 2006, a joint effort between the ADA and the American Heart Association was announced. This effort urges health care providers to enhance methods of evaluating and reducing risk factors for CVD and diabetes.⁶ More information on these programs can be found at the Web sites of these organizations (see box).

Patient Education

When counseling patients with diabetes about CV risks, it is important for pharmacists to evaluate the patients' current diabetes care plan, as well as to ascertain their knowledge of CVD and their awareness of their own individual risk factors. It also is important for the pharmacist to utilize counseling strategies that do not overwhelm patients, but rather empower them to effectively manage their diabetes.

Pharmacists can educate patients with pertinent information about their prescribed pharmacologic therapy, in conjunction with reinforcing the various means of minimizing their CV risks, such as the following:

• Adhering to medication therapy
• Maintaining optimal blood glucose levels by routine testing
• Routine monitoring of blood pressure as well as lipid profiles
• Adhering to lifestyle modifications such as diet, exercise, and maintaining a healthy weight
• Avoidance of smoking, because smoking in diabetics doubles an individual's CV risk
• Scheduling regular visits with a physician
• Practicing good oral hygiene

Pharmacists also can encourage patients to discuss concerns with their physician (eg, whether they are candidates for aspirin therapy to reduce CVD).

Clinical studies have shown that control of blood glucose, blood pressure, and lipid levels can significantly decrease an individual's risk for CVD. It is the responsibility of all health care professionals to ensure that diabetics are aware of the connection between CVD and diabetes. Combating a disease such as diabetes requires a multifaceted approach. Through effective patient education, health care professionals may have a significant influence in reducing or preventing the progression of CV complications in the diabetic patient.

Furthermore, pharmacists can positively impact patient outcomes by assuring diabetic patients that, although diabetes is a serious condition, it can be effectively managed if they remain committed to all aspects of their treatment plan. In addition to counseling diabetic patients about their medications, pharmacists can be a valuable asset in the management of diabetes by routinely asking patients about their blood glucose levels and by making recommendations to physicians about therapeutic alternatives that may optimize patient outcomes.

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Rybovic, Pharmacy Times, Ascend Media Healthcare, 103 College Road East, Princeton, NJ 08540; or send an e-mail request to: arybovic@ascendmedia.com.