Academic journal article American Journal of Pharmaceutical Education

An Elective Course to Train Student Pharmacists to Deliver a Community-Based Group Diabetes Prevention Program

Academic journal article American Journal of Pharmaceutical Education

An Elective Course to Train Student Pharmacists to Deliver a Community-Based Group Diabetes Prevention Program

Article excerpt

INTRODUCTION

Diabetes affects over 29.1 million citizens--9.3% of the population--in the United States. (1) Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputation, and new onset blindness in American adults, and it is a major cause of heart disease and stroke. As such, diabetes is the seventh leading cause of death in the United States. (2) The estimated diabetes-related costs nationwide in 2012 exceeded $245 billion, with the average health care costs for a person living with diabetes exceeding $13 700 per year as opposed to $5800 for a person without diabetes. (3) In addition, 35% of adults over age 20 and half of all adults over age 65 years have prediabetes. (4) Without changes in lifestyle and improvement in health, 15-30% of these people will develop type 2 diabetes mellitus in the next five years. (4) This high proportion of people at risk for diabetes, and the costs of treating diabetes-related conditions, presents a potential health care crisis related to personal and societal costs, if these trends continue and progression to diabetes is complete.

Pharmacists are highly accessible and effective health care professionals for people living in urban, suburban, and rural locations. (5) Pharmacists are uniquely positioned to provide services related to diabetes prevention for several reasons: convenient location of pharmacies, accessibility of pharmacists for questions and counseling (eg, appointments not usually required), strong rapport that pharmacists and their staff develop with patients and their families, and frequent contact pharmacists have with health care providers in their community. Although the public image of pharmacy is often related to the task of dispensing, a primary focus for pharmacists is on the appropriate, safe, and effective use of medications and, importantly, health promotion to prevent illness. Core training in pharmacy education includes motivational interviewing, basic nutrition, behavior modification, and health promotion strategies to prevent conditions like diabetes. In fact, currently published educational outcomes and accreditation standards emphasize that pharmacy curricula include training for students in how to design prevention, intervention, and educational strategies that manage chronic disease and improve health and wellness. (6,7)

Numerous controlled trials demonstrate that pharmacists make a significant impact on improving control of conditions related to diabetes including lipid, blood pressure, and glucose levels, as well as promoting smoking cessation among patients. (8-16) Additionally, pharmacies are effective sites for patient screening and education about diabetes risks. (17) Preparing practicing and student pharmacists to deliver diabetes prevention services in their accessible, community-based pharmacies leverages great potential for reaching citizens and impacting the diabetes epidemic.

The Diabetes Prevention Program (DPP), an intervention using lifestyle modification, has successfully reduced the development of diabetes in individuals with prediabetes by 58% over a 3-year period. (18,19) The longterm follow-up study reported that participants in the DPP continue to benefit from the program even 10 years later, with diabetes incidence reduced by 34% in the lifestyle modification group compared to placebo. (20) Since 2002, the DPP curriculum has been modified into a group delivery model and provided in a variety of urban, semi-urban, and rural settings using nurses, health educators, volunteer health professionals, nutritionists, dietitians, exercise physiologists, and fitness specialists as coaches. (21) The most widely implemented diabetes prevention program has been delivered through the Young Men's Christian Association. (22) Yet, few reports have been published about pharmacists offering such services. (23,24)

Reports on teaching student pharmacists to provide lifestyle change intervention and education have been published. …

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