A growing number of adult and pediatric patients are being diagnosed with type 2 diabetes, despite increases in care modalities.
Mary Taylor, PharmD, BCACP, CDCES, CPP, a clinical pharmacist and diabetes educator at Cone Health Medical Group Pediatric Specialists in Greensboro, NC, joins with Pharmacy Times to discuss different facets of diabetes care in the pharmacy setting— empowering the patients, helping them improve diabetes technology literacy, addressing their concerns and educating them about disease management. Taylor also dives into the rapid shift in diabetes care that has occurred alongside a rapid increase in diabetes diagnoses.
PT Staff: How are patients like when they first get to you? What's your role in helping them (i.e., figuring out necessary medications, treatments options, [referrals], etc…)
Mary Taylor, PharmD, BCACP, CDCES, CPP: Great question. Yes. I feel like, for the most part, my patients are overwhelmed. It's really a huge lifestyle change to be diagnosed with diabetes, especially type 1, where they must do multiple daily injections of insulin and start carbohydrate counting. Even type 2 can be overwhelming, just with a child having to think about being more active being eating healthier choices.
I think the pharmacist has a huge role for these patients, whatever setting that you're in. So, I think the pharmacist knows the data with the therapies- we know how to make it as appropriate as possible for that specific patient regarding their medication regimen, what would be a good agent to add, and how to adjust that agent. I think we also serve as a huge guide for navigating the cost of different therapy options, because you can come up with the best medication plan that you want, but if the patient can't afford it, it doesn't really matter because they're not going to take it. [The pharmacist, if] inpatient, can think about transitions of care, [and] outpatient.
I think that pharmacists can [also] help with a collaborative practice agreement, explaining all the different medication options and even counseling the patients on the medications, and then diabetes technology, I think that is just huge, expanding with continuous glucose monitors, insulin pumps, [and] smart insulin pens. I think it's so much information in it is important to understand the technology and how it affects the medication, so that's another great role for the pharmacist.
And [it’s important to] explain to the patient how they are going to manage this disease state. That's a huge lifestyle change in how they're going to be able to implement it feasibly in their life. I think that's the thing with diabetes, people hear so many different things, “Oh, I can't eat that. I can't do that.” But really, they can do a lot of different things. And it's just empowering them so that they can make all appropriate changes.
PT Staff: What kind of techniques and tactics do you use to propel patients to not only stay with these changes, but want to?
Mary Taylor, PharmD, BCACP, CDCES, CPP: So I think the biggest thing is having someone understand why we are doing these changes. So many times, in healthcare, you're going to the doctor, and you get 20 minutes at most to explain “Okay, this is what's happening, this is what we're going to do.” There's not enough time hearing how the patient's thinking, how they're feeling, what their concerns are, and being able to listen to that patient and address those concerns so that you're both working on the same team. I think this is how you do it, you must educate them.
PT Staff: Can you talk more about the shift in care? I feel like it's been pretty exponential…
Mary Taylor, PharmD, BCACP, CDCES, CPP: I really feel like I've seen this shift. I tried to read as much as I can to stay up-to-date. [So before the] long-acting once-a-week insulin that came out… I'm sorry, the once-a-day insulin that came out in the early 2000s, there was something called insulin NPH (neutral protamine Hagedorn). It had more erratic pharmacokinetics, and it was harder to dose the medication. Patients had to be very regimented on the foods that they ate so that they could stay safe on their insulin dose, and that's all we had. So patients had to live very regimented lives.
Even when you were diagnosed with diabetes, you were typically told you weren't going to live longer than age 50 or 60—you weren't going to live that long. And how they managed their diabetes was vastly different in the 1980s, I think it was 1 of the first like home blood sugar meters that was it was like a catapult; you heard a wind it back and then it would stab your finger and you had to wait 5 minutes to get a reading. How often are people going to want to do that?!
There was not much that they could do to modify it to help make this regimen easier for them, versus now where we have multiple different kinds of insulin; we have long-acting insulin, rapid-acting insulin, ultra-rapid acting insulin, insulin pumps… it used to be [where] you had to be admitted to a hospital to start an insulin pump and now, at my clinic, we're starting patients on an insulin pump within a month of being diagnosed. It's going from a very fixed regimen to lifestyle to all these different options.
I also think it's important to know that— despite therapy changing and seeing how many people are diagnosed and are going to be living with this and how often is this going to have to be managed— [diabetes] is severely increasing. In 2019, there was a statistic from the CDC that 11% of the population has diabetes (adults). Okay, so it's a public health crisis. We know this.
But what I think is very interesting is that, in the pediatrics study that came out, there's going to be a 700% increase in type 2 diabetes (in the next 4 decades). So I think that there's a lot of great things happening right now—lots of different options— but we're going to need to continue to do research and find new options to help prevent these complications and help focus on weight management. That can go hand in hand with a lot of this, so its just making sure that we can start focusing on this holistically.