Type 2 Diabetes Mellitus and Cardiovascular Disease - Episode 7

Community Pharmacy Diabetes Support Groups

Troy Trygstad, PharmD, MBA, PhD; Tripp Logan, PharmD; Dhiren Patel, PharmD; and Javier Morales, MD, FACP, FACE, discuss the powerful impact of community pharmacy diabetes support groups in educating patients about their disease as well as treatment options and medication administration.

Troy Trygstad, PharmD, MBA, PhD: Let’s step back for a second. Thank you for that. We have a lot of new therapies in the marketplace. We know about the increasing emphasis on cardiovascular disease, Tripp. We’re thinking about that, and we’re thinking about treating patients with diabetes. But patients with diabetes also have a lot of other comorbid conditions. They have behavioral health issues. We know that a large percentage of the severe and persistent mentally ill have diabetes, as well as concerns around diabetes and the risks associated with diabetes progression from both the condition and with therapies. We know that it’s disproportionate, in many ways, to low socioeconomic status in certain areas of the country. It’s a community-wide issue. We have a lot of therapeutics. We’ve covered a lot of that. But, now we are going to go back to keeping it real in the community. When we think of a patient with diabetes in Charleston, Missouri, and think about treating a patient with diabetes in Charleston, Missouri, what does that effort look like, beyond, “Here’s the condition. Here’s the best treatment for that condition?”

Tripp Logan, PharmD: We had a really exciting exercise in science, just now. I’m really excited that this science is there. So, now we have to apply this science. It’s really tough, in the community. We’ve got this really exciting science. We want to apply it. But, the patient has to go home and have Thanksgiving dinner with the family, and he or she was just diagnosed with diabetes and doesn’t know what to eat. Sometimes, I get overexcited about programs in our pharmacy. I overshoot what we need to do and have to be reeled back in.

We started with some diabetes education. We were really going to set up appointments and work with these patients, bring in dietitians, try to refer for eye exams, and do all of these things in collaboration. Part of it was a support group meeting. And so, we built this whole infrastructure. I spent a whole lot of my dad’s money in the pharmacy, remodeling stuff which I’ve done many, many times with little return. And, over and over again, the patients were saying, “Can we just have that in a group?” I think we’re now in our 10th or 11th year of a support group. It’s great. You can have the best intentions when you’re sitting in the office or in our consultation room. But then, when that patient walks out and goes home, life hits them. It’s totally different. So, you need to bring family into this. The whole patient isn’t just the patient, but is everybody who surrounds them. So, it’s all about teaching them how to prepare a dish that they can take to the meal, that is alright for them to eat, and doing other things that allow them to stick to this care plan, outside of the walls. It’s never going to work just on the science. It’s never going to work based on what we decide is a good idea inside the walls of our offices. It goes into the community.

Troy Trygstad, PharmD, MBA, PhD: That’s pretty well established with behavior change, at this point. We know that from smoking cessation. We know that from addiction to alcohol, the environment, your social interactions, and so on, and so forth. You’re in a community and you have to take that into consideration, especially in a small town where everybody knows each other.

Tripp Logan, PharmD: We try to get them to bring their family members in. “Once you get established in the support group, bring your family members. They need to hear this too. They need to understand what you’re going through.” And then, they can learn what does or doesn’t work from each other.

Dhiren Patel, PharmD: Yes, loneliness is a risk factor. It’s been equated as equally as bad as smoking. It’s real. It happens. You feel like you’re the only one who is going through it. I could say something. You could say something. But, that same message, as delivered by one of their peers, who actually has it—completely different.

Tripp Logan, PharmD: It’s a game changer.

Dhiren Patel, PharmD: “Oh, he did it. He started checking his blood sugars.” Or, “He started on insulin and did better.” It’s kind of like when your parents don’t listen to you, but when the neighbor says it, they’re like, “Oh.” You are saying, “I’ve been telling them that for the last 5 years.” It’s the same concept.

Tripp Logan, PharmD: One of our best topics is around insulin and the fears of insulin. We go over all of the needles. We’ve had a lot of patients initiated on insulin, who had not been but should have been for years. This changed based on the comfort they felt from their peers, who said, “It’s OK. You’ll actually feel better afterwards.”

Troy Trygstad, PharmD, MBA, PhD: Or, the perception of the provider in making the assumption that….

Tripp Logan, PharmD: It’s a penalty.

Troy Trygstad, PharmD, MBA, PhD: That it’s a penalty. There’s a barrier, there, that may not exist with every patient.

Tripp Logan, PharmD: “I’m going to have to put you on insulin.”

Javier Morales, MD, FACP, FACE: One of the challenges is with what we call “health-care literacy.” Most people are literate in the English language. But, are they health literate? Do they know about their disease and what to expect? Do they know when to intensify? Do they know about the progressive nature of type 2 diabetes? Often, patients don’t understand it. So, recruiting these family members does further emphasize those needs in the home. The other thing that’s also very important is culture. There is a very important twist to this. We’re a nation of multiple nations and multiple nationalities, and race may make a difference in terms of perception of disease. We see it with the Asians. We see it with the African Americans, and certainly with the Hispanics. This all plays into health literacy.

Tripp Logan, PharmD: Just the culture of our nation. Look at the commercials. Look at the number 1 selling drink. Food—it’s not necessarily a nutritional substance anymore. It’s just something you put in your body. There are a lot of negative effects that can happen with a lot of that. So, changing that dynamic is huge. Turning that ship is going to be really, really hard.

Troy Trygstad, PharmD, MBA, PhD: Sure. It’s a lot to ask. We ask teachers to transform communities. We ask health-care professionals to transform communities. It’s a broad challenge.