The Diabetes Epidemic: An Opportunity for Pharmacy

Does the explosion of diabetes in the United States provide a special opportunity for pharmacists?

In Diabetes at a Glance 2010, the National Center for Disease Prevention and Health Promotion (http://cdc.gov/chronicdisease/ resource/publications/AGG/ddt. htm) offers this summary:

-23.6 million people in the United States (7.8% of the total population) have diabetes. Of these, 5.7 million have undiagnosed diabetes.

- In 2007, about 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older.

- African American, Hispanic, American Indian, and Alaska Native adults are twice as likely as white adults to have diabetes.

- If current trends continue, 1 in 3 Americans will develop diabetes sometime in their lifetime, and those with diabetes will lose, on average, 10 to 15 years of life.

- Diabetes is the leading cause of new cases of blindness, kidney failure, and nontraumatic lower-extremity amputations among adults.

- Diabetes was the sixth leading cause of death on U.S. death certificates in 2006. Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

- In 1999 to 2000, 7% of U.S. adolescents aged 12 to 19 years had impaired fasting glucose (prediabetes), putting them at increased risk of developing type 2 diabetes, heart disease, and stroke.

Does this explosion in diabetic cases provide a special opportunity for pharmacists? I think it absolutely does, but maybe it will require a different approach to pharmacy practice. The New York Times article (8/15/2010) “Pharmacists Take Larger Role on Health Team” quotes pharmacist David Pope: “We are not just going to dispense our drugs, we are going to partner with you to improve your health as well.” Is that a novel role that a few pharmacists can play or does that approach represent the new direction that most pharmacists must take to secure their role as health care reform begins changing our current health care system?

Not only does a disease management role provide a new revenue stream for pharmacy, it also begins to address a real societal need. Diabetes is an epidemic with many undiagnosed patients and many diagnosed patients who are uncontrolled with their disease.

Which health professional is in the best position to intervene in this problem? More patients are likely to see a pharmacist than any other health professional because community pharmacists are so accessible. Now that more than 50% of the population takes at least 1 prescription drug, patients come into the pharmacy regularly.

Pharmacists can participate in health screening programs to help identify individuals who are undiagnosed. Further, they can work with newly diagnosed patients with diabetes to help them better understand their disease and its treatment. Finally, the pharmacist can serve as a patient disease management coach to keep patients accountable to meet agreed-upon care goals.

Very positive results have been demonstrated where pharmacists have accepted their roles and worked collaboratively with the health team. These studies show that pharmacists can make a significant difference, improving clinical parameters and at the same time reducing costs. After all, that is what health care reform is all about.

So, the real questions are: Do pharmacists want to assume this new role? Are pharmacist employers willing to make the necessary transition in the practice model to allow pharmacists to perform these functions?

Bill Gates said that we overestimate how much change will occur in a few years and underestimate how much change will occur in a decade. I hope I am around in 2020 to look back and see how many pharmacists stepped up to the plate and accepted the challenge to partner with their patients to improve their health. I believe our pharmacists will accept the opportunity–and our patients and our health system will be the beneficiaries. Are you willing to be one of them?

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.

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