Diabetes Watch

SEPTEMBER 01, 2008

Pharmacists Counsel, Educate Diabetes Patients

As the number of individuals with undiagnosed and diagnosed diabetes rises, there is an even greater need for pharmacies to offer specialized care for this patient population.

Medicine Shoppe and Medicap Pharmacies have 100 stores that now operate Specialized Care Centers for diabetes (SCC-Diabetes), helping patients better understand their illness and track, analyze, and comply with their physicians' recommendations. As part of the program, nearly 200 pharmacists have received certification as diabetes managers.

The pharmacies operating an SCCDiabetes Center provide patients with quarterly educational programs or support groups on topics affecting patients with diabetes; monthly downloads of blood glucose meter reports (consenting patients also can have the report sent to their physician free of charge); training on blood glucose monitors and insulin pens; and informational materials from pharmaceutical manufacturers. The pharmacies also offer personalized, monthly counseling sessions with educational materials to assist patients in managing diabetes.

Two-prong Approach Urged for Prediabetes

Experts from the American Association of Clinical Endocrinologists (AACE) recommend that lifestyle modifications, along with a reduction in heart disease risks will help prevent prediabetes from progressing to the full-blown disease.

The first step is lifestyle changes such as diet and exercise. The AACE also thinks that prediabetes needs to be treated more aggressively. Because no drug therapies for treating prediabetes have been approved by the FDA, the AACE has proposed an alternative: reduce the number at which blood sugar levels define diabetes. The change would make current medications available to patients who are now classified as prediabetic. Patients who cannot modify their cardiovascular risk with lifestyle changes need to be treated for hypertension and high cholesterol and should have medications to control blood sugar levels.

Undiagnosed Diabetes: HbA1C Test May Help

A national panel of health care experts suggests that the hemoglobin A1C (HbA1C) test used to monitor patients with diabetes may also help in identifying individuals with undetected diabetes.

In a consensus statement, published in the July 2008 issue of the Journal of Clinical Endocrinology and Metabolism, the researchers concluded that the HbA1C test should be used as a front-line method for detecting patients with the disease, especially for those at high risk for diabetes. The test does not require fasting and is not affected by short-term changes in diet and exercise.

The consensus group recommended that patients who score at least 6% on the HbA1C test may have or be at risk for diabetes and should be monitored with additional glucose or HbA1C tests. The patients who score 6.5% and above, if confirmed, should be considered to have diabetes.

Gestational Diabetes Ups Type 2 Diabetes Risk

Gestational diabetes greatly increases a woman's risk of developing type 2 diabetes later on, according to a new study reported in the July 29, 2008, issue of the Canadian Medical Association Journal.

Diagnosing and treating type 2 diabetes is critical if a woman plans to become pregnant again, because poorly controlled diabetes in pregnancy ups the risk of fetal malformations and stillbirth. For the study, the researchers gauged the exact degree of risk after looking at 633,449 women who gave birth in Toronto between 1995 and 2002. Of the women, 21,823 were diagnosed with gestational diabetes.

Although the findings showed just 2% of the women who did not develop gestational diabetes went on to develop type 2 diabetes during the 9-year follow-up period, 19% of those with gestational diabetes did.

Diabetes, TB Link Found

A review of published studies indicates that patients with diabetes also are at risk of developing tuberculosis (TB). As a risk factor for active TB, the growing prevalence of diabetes may impact the global efforts to control TB, reported the researchers in PLoS Medicine (July 2008). For the study, the researchers found 13 studies including >1.7 million participants (n = 17,698 TB cases). Combining the data from some of these studies, the researchers calculated that having diabetes raised the risk of active TB three-fold. This increase suggests that diabetes may already be the cause of >10% of TB cases in India and China.

F A S T   F A C T: More than 56 million Americans currently have prediabetes, according to the Centers for Disease Control and Prevention.