For many community pharmacists, diabetics form a significant percentage of their regular patients. That’s not surprising given that the CDC estimates that more than 30 million Americans have diabetes and most patients with diabetes have monthly prescriptions. Frequently, diabetes patients take multiple antihyperglycemic drugs, and many also require medications to treat common comorbidities such as hypertension and dyslipidemia. A plan to comprehensively meet the needs of diabetes patients, though, goes far beyond just filling prescriptions.
Both administration of diabetes medications and management of blood glucose levels create demand for specific supplies. Patients for whom oral medications such as metformin have proved inadequate frequently add one or more injectable therapies, including various forms of insulin, amylin analogues, and GLP-1 inhibitors, each of which requires syringes or pen needles. In addition, the need to test blood glucose levels throughout the day means that diabetes patients use a continuing supply of blood glucose meters, test strips, lancets, and related devices. Those with continuous glucose meters need a supply of sensors and transmitters, while patients with insulin pumps must have replacement infusion sets and cartridges or reservoirs, as well as skin adhesives.
A basic necessity for diabetics is sterile wipes. Many patients also use glucose tablets to quickly reverse hypoglycemia. Sugar-free cough syrups, cold medications, and nutritional supplements help diabetes patients better manage their glucose levels when they are ill.
Because hyperglycemia increases the risk of nerve damage and infections, particularly in the lower extremities, pharmacies catering to diabetics often carry specialty items designed to maintain foot health. These items range from fundamentals such as toenail clippers and moisturizing lotions to insoles for shoes, pads to protect feet from blisters, extra-wide or light compression socks, and adjustable, padded slippers and shoes.
Patients who have early peripheral neuropathy may benefit from OTC capsaicin creams to help manage pain, while those with more advanced nerve damage will need prescription products. Wound-care products include essentials such as gauze, tape, and flexible bandages in a range of sizes and specialty products such as polyvinyl films and hydrocolloid dressings.
“In theory—and unfortunately, sometimes in practice—patients with diabetes can walk out of pharmacies with the right medications and OTC diabetes products and not improve their health status,” said Laurie Jamieson of McKesson US Pharma. Having the right products on hand helps, but pharmacists can assist patients with diabetes the most by using their unique skill set to educate and engage them in their own care.
Jamieson recommends that pharmacists focus on five actions that can significantly improve diabetes care for their patients:
Reconcile medications: When patients pick up diabetes medications, pharmacists should use the opportunity to ensure that patients are receiving the right drugs for their specific situation and that their diabetes medications are not contraindicated by other drugs they take or any comorbidities.
Ask about medication use and issues: Physicians often do not have time to explain how to inject insulin or other drugs. A few minutes of a pharmacist’s time can give a nervous new patient greater confidence, minimize complications, and improve overall outcomes from therapy. Asking about side effects can identify issues that may be interfering with adherence to therapy.
Help with product selection: Patients often use brands or products recommended by their physicians, but those might not be the best for their particular needs. Older patients or those with impaired vision may need a larger screen on their glucose meter. Younger patients may want to track their results with an app on their phone.
Explain proper product use: Newly diagnosed patients may be uncertain how to properly use a lance. Others may have trouble replacing parts in insulin pumps or glucose meters. A few minutes of conversation or a demonstration could make a big difference to a frustrated or fearful patient.
Educate about diabetes and comorbidities: A patient who only picks up his medication every other month may not be aware of the risks associated with poorly controlled hyperglycemia or understand what his glucose measures really mean. A patient who has recurrent infections might not know that she needs to discuss them with her physician or that they are related to her diabetes. Others may not realize that an illness or infection can significantly affect blood glucose levels or the importance of managing hypertension.
With the right balance of medications, products, and time spent talking with patients, pharmacists can help their patients take control of their diabetes and build a reputation for comprehensive care that can boost revenues from this growing market segment.
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