Diabetes and Rural Areas: Pharmacists Identify Neuropathy

Diabetes is quickly becoming a rural problem in the United States, where its incidence has been reported to be 17% higher in rural areas than in cities. Patients in rural areas who have diabetes often have lower access to care and are more likely to be uninsured, hospitalized, or poor. Nationally, between 28% and 45% of patients who have diabetes develop diabetic neuropathy, which often leads to unregulated glycemic control if left untreated.

Researchers from the Department of Pharmaceutical and Administrative Sciences at Presbyterian College School of Pharmacy in Clinton, South Carolina have published an article in the Journal of Pain Research that reviews data collected by a free, pharmacist-led diabetes education clinic. They found that the vast majority of patients who were treated for diabetic neuropathy did not receive guideline-directed care.

This free clinic generally sees patients with poor glycemic control or who need additional assistance managing their disease. Patients also tended to have low health literacy.

The researchers enrolled 111 patients who had diabetes and found that 67% of them had diabetic neuropathy. Among patients who reported concurrent pain, 26 or approximately half had been diagnosed by their physicians. Pharmacists identified 12 additional patients who were experiencing pain.

This research indicates that more than 60% of patients who had diabetic neuropathy were undocumented and undiagnosed. Men were more likely to develop diabetic neuropathy than women in this rural location, which is opposite of most other study findings. In addition, patients who developed painful diabetic neuropathy tended to be approximately 12 kilograms lighter than those who did not.

Twenty patients were treated for painful diabetic neuropathy and received appropriate pharmacologic agents at baseline. However, when their care was measured against clinical guidelines, it was suboptimal. The most common prescribing problem was subtherapeutic dosing.

Prescribers used gabapentin most often. They also used opioids, antidepressants, meloxicam, and muscle relaxants. Polypharmacy was common.

The researchers concluded that pharmacist intervention has been shown to improve glycemic control, reduce blood pressure, and improve adherence and other areas. They indicated that pharmacists can identify diabetic neuropathy and help patients experiencing pain receive better care.

Reference

Pruitt J 3rd, Moracho-Vilrriales C, Threatt T, et al. Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina. J Pain Res. 2017;10:833-843.