Supporting patients who need help managing their diabetes

Many patients who visit the pharmacy have diabetes. How many of these patients actually have their diabetes well controlled or even know how to properly monitor their blood glucose? Unfortunately, this inquiry made by pharmacists often only happens sporadically when an issue arises or when an annual medication review is due. Even when the conversation is initiated, often patients do not recall or have their blood glucose readings readily available. In fact, multiple studies including a meta-analysis (Khunti, et al, 2018) have shown only 43% of patients with diabetes globally are able to achieve optimal glycemic control based on guidelines recommendations.

This widespread under-management of diabetes is critical to the long-term outcome of patients and healthcare’s growing costs in diabetes management. We know from the original UKPDS landmark trial that even a 1% A1c decrease can have meaningful reductions in both macro and microvascular complications as well as all-cause mortality. Such complications can often lead to life-threatening cardiovascular events, blindness, amputations and/or kidney failure severely impairing one’s quality of life. This is a big gap in diabetes care despite of all the treatments, resources and knowledge available in the modern age.

One often overlooked area in diabetes care is in optimizing blood glucose monitoring to ensure the correct use of one’s glucometer. Often in practice, we see patients either over-testing or not testing at all. Even those patients who test correctly, often may not know how to interpret the results and take the appropriate corrective actions. This pervasive issue can most ideally be addressed by the pharmacist, by providing pharmacists with more effective tools in coaching and monitoring patients. Such novel glucometers have been available on pharmacy shelves for many years and are even now more commonplace and powerful. These enhanced novel glucometers have been designed for its ease to use, connectivity and time-saving features, empowering patients and the healthcare providers in better diabetes management.

The integration of mobile technology in healthcare applications is key to increasing patient involvement and compliance to their therapy. In 2016, 74% of Canadians owned a smartphone (up from 68% in 2015). The younger population of patients with diabetes have widely adopted new technologies, but increasingly seniors are also becoming more tech-savvy and open to novel tools in diabetes management. This new generation of glucometers have Bluetooth connectivity, app enabled and provide easy to interpret colour coding of results. The built-in technology allows pattern identification and often lifestyle and dietary tracking. With all this information readily accessible, glucometers serve as an active coaching and mentoring tool to encourage proper frequency and timing of self-monitor of blood glucose. This technology had enabled many pharmacist and physicians to more easily access complete blood glucose histories and identify problematic patterns through the software with a fraction of the time and higher accuracy compared to traditional log books. Patient data can also be shared by the patient remotely prior to a pharmacy or doctor’s visit to help streamline the discussion.

A majority of patients are not at glycemic target, highlighting a need for better management tools and behavioural changes. Adoption of improved self-monitoring technology is an important piece in supporting both the patient and healthcare professional in obtaining treatment goals.

Wilson Li graduated in 2009 from UofT’s Leslie Dan Faculty of Pharmacy and began his pharmacy career at Shoppers Drug Mart. Wilson became a CDE pharmacist in 2012 and organizes regular A1c clinics while collecting patient data for practice-based research. Most recently, Wilson and his team completed a national community-pharmacy-based A1c study with over 1000 patients across the country. His team’s results were published in the International Journal of Pharmacy Practice (IJPP) as a proposed Canadian model for Diabetes Care.