Improving Collaborative Care in Diabetes - Episode 1
Broad Impact of Metabolic Syndrome
Troy Trygstad, PharmD, MBA, PhD; Steven Peskin, MD, MBA; Dhiren Patel, PharmD; and Richard Wynn, MD, outline the clinical and economic burdens of diabetes and the metabolic syndrome on patients, managed care, and community physicians.
Troy Trygstad, PharmD, MBA, PhD: Thank you for joining us for this Pharmacy Times® Peer Exchange® panel discussion. A team approach is essential to improving outcomes for patients with type 2 diabetes. Pharmacists are increasingly taking on a provider role in the frontline when it comes to providing patient education, addressing barriers to adherence, and communicating to physicians about therapeutic optimization. This Peer Exchange® will explore the role of the pharmacist in improving diabetes care. And we’ll discuss the challenges and opportunities for better collaboration among members of the health care team.
I’m Dr. Troy Trygstad. I’m the vice president of Pharmacy Provider Partnerships at Community Care of North Carolina, located near Raleigh, North Carolina. I’m also the editor-in-chief for Pharmacy Times®. Participating in today’s discussion are our distinguished panelists Dr. Tripp Logan, community pharmacist and pharmacy owner in Charleston, Missouri, and partner at MedHere Today; Dr. Dhiren Patel, associate professor of pharmacy practice at Massachusetts College of Pharmacy Health Sciences University, located in Boston, Massachusetts, and clinical pharmacy specialist for Veterans Affairs of Boston Healthcare System, in Boston, Massachusetts; Dr. Steven Peskin, executive medical director for Horizon Blue Cross and Blue Shield, and associate clinical professor at Robert Wood Johnson Medical School of New Brunswick, New Jersey; and finally, Dr. Richard Wynn, clinical instructor at University of North Carolina Chapel Hill, partner at AGF Valentine Family Medicine, and family physician in Charlotte, North Carolina. Thank you all so much for joining us. Let’s begin.
As a panel, we want to discuss the clinical and economic burden of diabetes in the United States, today. And to frame this discussion, I think it’s important to remind ourselves that roughly 30 million people have diabetes in the United States, and roughly 84 million folks have prediabetes. That’s about one-third of the adult population. Steven, I’d like to start with you. What is the global economic and humanistic burden of diabetes in the United States, today?
Steven Peskin, MD, MBA: Troy, that is a great question. Unquestionably, this is one of the most profound, serious consequential clinical conditions that we, as a society, face. And we face it increasingly, globally. We’re seeing the increase in diabetes in the developing world, as well as in the developed world. The numbers are increasing. We see the confluence of diabetes with other chronic conditions. So, we really recognize that diabetes is extremely consequential. It has a profound impact and a profound burden on the health of our population. It leads to many chronic conditions, or is associated with and is an accelerator of many chronic conditions. We see the total cost of persons with diabetes being substantially higher than other persons. And again, the absolute numbers are just staggering.
Dhiren Patel, PharmD: To add to that, if you just look at our population, you mentioned diabetes, we still have a lot of work to do in glycemic control for those that are diagnosed with it. We know that about 40% to 50% are not at goal with their A1C. Another 20% to 30% are in an A1C goal greater than 8%. We’re not even talking about those patients that are in the pipeline—the other 86 million that you mentioned—who don’t even know that they have diabetes. And so, again, extrapolate that. Multiply that. You can kind of see how this economic burden is going to get bigger and bigger.
Troy Trygstad, PharmD, MBA, PhD: What I hear you saying is, there are problems and opportunities, and there’s ample opportunity out there?
Dhiren Patel, PharmD: Absolutely.
Richard Wynn, MD: I think that it’s underrecognized. It’s not just a multi-system disease. It’s a family disease. The cost of it is extraordinary. And the impact on employment, attendance at work, well-being of the family is extraordinary. So, managing it is a family problem.
Troy Trygstad, PharmD, MBA, PhD: So, what you’re describing in a family practice is that you have patients with diagnosed diabetes. When those patients come to the office, they’re bringing with them more than just their diabetes?
Richard Wynn, MD: Yes. Diabetes plus the consequence of the diabetes. The cost of their care is exceptional, and it changes decisions made by the rest of the family for all kinds of things; educational opportunity is included. There is an impact on the family’s choice of diet and activities. And it requires the entire family to get involved to help the diabetic patient improve their condition. If they don’t, the rest of them will follow with the diabetic disease as well.
Troy Trygstad, PharmD, MBA, PhD: As a proportion of your total activity and practice, and you have a small family practice, what percentage of your total activity revolves in and around diabetes?
Richard Wynn, MD: In my practice, particularly, it is about 40%.
Troy Trygstad, PharmD, MBA, PhD: Of all of the activity going on in the practice?
Richard Wynn, MD: It’s a touch-intensive disease. It’s not just, “OK, you’ve got this. I’ll prescribe this. Take that and you’ll be fine.” It’s “How’d you take that? When did you take that? What are you eating?” And “Are you exercising? How are you doing?”
It’s other areas of your life that are impacted by it. So, it takes a lot of support. There are so many messages in our society that lead against diabetic control, from our economy that pushes the worst type of food on people, and the so many programs that are pushing low fat diets instead of a more modern high-protein, low-carbohydrate diet that leads away from diabetes
Steven Peskin, MD, MBA: Richard, I’m still seeing patients one afternoon each week, which I enjoy tremendously. Diabetes, hypertension, and dyslipidemia. I can’t tell you how many times the resident comes in and says, “Dr. Peskin, this 56-year-old Hispanic is in today with diabetes, hypertension, and dyslipidemia.” Or, “High cholesterol.” So, it’s very, very common. I don’t know if it’s 40%, but it’s very high.