Mary Taylor, PharmD, BCACP, CDCES, CPPclinical pharmacist and diabetes educator at Cone Health Medical Group Pediatric Specialists in Greensboro, NC, joins Pharmacy Times to discuss various aspects of diabetes care in the pharmacy—empowering patients, helping them improve diabetes technology literacy, addressing their concerns, and educating them about disease management. Taylor also dives into the rapid change in diabetes care that has occurred alongside a rapid increase in diabetes diagnoses.
Personal PT: Hwhat are patients like when they first come to you? What is your role in helping them (ie, finding needed medications, treatment options, [referrals]etc…)
Mary Taylor, PharmD, BCACP, CDCES, CPP: Great question. Yes. I feel that, 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 have to take multiple daily insulin injections and start counting carbs. Even type 2 can be overwhelming, just with a child having to think about being more active by eating healthier options.
I think the pharmacist has a huge role for these patients, no matter what setting you’re in. So I think the pharmacist knows the data with the treatments—we know how to make it as appropriate as possible for that particular patient in terms of their medication regimen, what would be a good factor to add and how to adjust that factor. I think we also serve as a huge guide for navigating the cost of different treatment 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 i take [The pharmacist, if] inpatient, can think about transitions of care, [and] hospital outpatient.
I think pharmacists can [also] helping with a partnership agreement, explaining all the different drug options and even counseling patients about the drugs, and then diabetes technology, I think it’s huge, expanding with continuous glucose meters, insulin pumps, [and] smart insulin pens. I think it’s so much information that it’s important to understand the technology and how it affects the drug, so that’s another great role for the pharmacist.
And [it’s important to] explain to the patient how he is going to manage this disease state. This is a huge lifestyle change in how they will be able to feasibly implement it in their lives. I think that’s the thing with diabetes, people hear so many different things, “Oh, I can’t eat that. I can not do that.” But really, they can do a lot of different things. And it just empowers them to make all the appropriate changes.
Personal PT: What kinds of techniques and tactics do you use to get patients to not only stick with these changes, but to want to?
Mary Taylor, PharmD, BCACP, CDCES, CPP: So I think the biggest thing is for someone to understand why we’re making these changes. A lot of times, in health care, you go to the doctor and you have 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 to listen to how the patient is thinking, how they’re feeling, what their concerns are, and to be able to listen to that patient and address those concerns so that you’re both working on the same team. I think that’s how you do it, you have to educate them.
Personal PT: Can you talk more about shifting care? I feel like that was pretty expository…
Mary Taylor, PharmD, BCACP, CDCES, CPP: I really feel like I’ve seen that shift. I have tried to read as much as I can to stay informed. [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 NPH (neutral protamine Hagedorn) insulin. It had more unstable pharmacokinetics and was more difficult to administer. Patients had to be very careful about the foods they ate so they could stay safe on their insulin dose, and that was all we had. So the patients had to live very regulated lives.
Even when you were diagnosed with diabetes, you were usually told you wouldn’t live past 50 or 60 — you wouldn’t live that long. And how they managed their diabetes was very different in the 1980s, I think it was one of the first home blood sugar meters that was like a catapult. you heard a wind turn it and then it stabs your finger and you had to wait 5 minutes to get a reading. How often will people want to do this?!
There wasn’t much they could do to modify it to make this regimen easier for them, compared to now where we have many 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 hospital to start an insulin pump and now, in my clinic, we start patients on an insulin pump within a month of diagnosis. It goes from a very fixed lifestyle regimen to all these different options.
I also think it’s important to know that – despite the fact that treatment is changing and we’re seeing how many people are diagnosed and will live with it and how often this will need to be treated – [diabetes] increases drastically. 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 that.
But what I think is very interesting is that, in the pediatric study that came out, there will be a 700% increase in type 2 diabetes (over the next 4 decades). So I think there are a lot of great things going on right now—a lot of different options—but we should continue to do research and find new options to prevent these complications and focus on weight management. This can go hand in hand with a lot of them, so we just have to make sure we can start focusing on that holistically.