Diabetes: Monitoring and Counseling Patients with Pre-Diabetes and Type 2 Diabetes

Article excerpt



Approximately 26 million Americans are currently diagnosed with diabetes, and another 79 million have been diagnosed with pre-diabetes, at a total cost to the economy of more than $175 billion per year. The prevalence of type 2 diabetes has been rising in parallel with the rates of obesity, and these trends highlight the growing importance of early detection of individuals with risk factors for diabetes such as obenty, physical inactivity, hypertension, cardiovascular disease, and elevated blood serum levels of glucose and lipids. Complications of diabetes are numerous and severe: In addition to sensory and autonomic neuropathy, they include diabetic retinopathy and diabetic nephropathy - the leading causes of blindness and kidney failure. While first-line therapy emphasizes nutrition therapy, exercise, and weight loss, medical interventions have also proven effective. These include medications to control hyperglycemia, dyslipidemia, and hypertension, as well as bariatric surgery. The pharmacist is in a unique position to play a critical role in diabetes care, by counseling patients in self-monitoring techniques, by helping to ensure that patients adhere to their prescribed medication regimens, by educating patients about adverse drug reactions, and by playing a central role in medication therapy management. The Asheville Project and Diabetes Ten-City Challenge demonstrated that a multimodal approach - including counseling, self-monitoring, lifestyle changes, and appropriate medication - can significantly reduce the risk of diabetes and the costs associated with both its treatment and its economic effects.

Diabetes mellitus is among the most common medical conditions encountered by healthcare professionals in the United States, The estimated U.S. prevalence of diabetes is 8,3%, or 25,8 million children and adults, with 1,9 million new cases diagnosed in adults in 2010. Equally important, it is estimated that currently 79 million people have pre-diabetes,1 The health consequences of uncontrolled hyperglycemia are many, including but not limited to cardiovascular disease (CVD), stroke, and neuropathy. Diabetes is the leading cause of nontraumatic lower-limb amputation, new cases of blindness, and kidney failure. G? addition, the total direct and indirect costs (e.g., from missed work days) of diagnosed diabetes alone were estimated at $174 billion in 2007. x Diabetes thus exerts profound effects on the healthcare system as well as on the individual patient. Pharmacists can play a large role in optimizing therapy for this medical condition.

Classification, definitions, and diagnosis of diabetes and pre-diabetes

Diabetes mellitus is classified into several different types. Type 1 diabetes is characterized by autoimmune destruction of the pancreatic beta cells, resulting in absolute insulin deficiency. This means that patients with type 1 diabetes cannot survive without insulin replacement therapy.

The majority (90% -95%) of diabetic patients have type 2 diabetes, however, a condition characterized primarily by insulin resistance (decreased glucose uptake by the liver and muscles) and a relative insulin deficiency, with progressive impairment of pancreatic beta-cell function, decreased insulin secretion, and eventual beta-cell failure.

Several other types of diabetes also exist, including gestational diabetes, diabetes from genetic defects of beta-cell function or insulin action, diabetes from endocrinopathies (e.g., acromegaly), and drug-induced diabetes.2 This article focuses on the monitoring parameters and education for adults with type 2 diabetes.

Rise of obesity

The prevalence of diabetes has been steadily increasing in the past 3 decades and parallels the rise in overweight and obesity in the United States,34 Overweight and obesity are strongly correlated with diabetes and pre -diabetes but may not completely explain the rise in the prevalence of diabetes,5,6 Other factors, such as the increase in the median age of the population, may play a role. …