Managing Diabetes and Cardiovascular Risk
Buckley, Bruce, Drug Topics
At the A. F. Williams Family Medicine Center in Denver, pharmacists Joseph J. Saseen and Laura Borgelt work side by side with physicians and other healthcare professionals, using their expertise in pharmacotherapy to enhance patient outcomes in a variety of illnesses. One major illness is Type 2 diabetes mellitus.
As part of their pharmacotherapy consult service at the family clinic, the two pharmacists are often called on to manage or comanage diabetes patients' therapy. They help patients keep their blood glucose levels under control, and they titrate the cholesterol and blood pressure medications of those who require such treatment.
"We also place them on aspirin therapy for prevention if needed, and if they're smokers, we try to do whatever we can to get them to quit," said Saseen. Abdominal obesity, which also intensifies cardiovascular risk, is another target of their patient education efforts.
Saseen and Borgelt pay a lot of attention to the cardiovascular status of their diabetes patients. That's because of the strong link between diabetes and cardiovascular events, such as myocardial infarction and stroke. Diabetes is a major risk factor for developing cardiovascular disease, which, in turn, is the leading cause of death for patients with diabetes.
Besides the patient consults, they also have what Saseen describes as an "informal educator" role, involving medical residents at the family clinic, which is part of the University of Colorado Health Sciences Center, where both pharmacists hold faculty appointments. "We do coprecepting with our physicians to help train medical residents," he said. "We work with them to make sure they're optimining all the drug therapies possible for patients with Type 2 diabetes."
By having their own patient consults-referred by clinic nurse practitioners and attending physicians-- and by acting as copreceptors for residents, the two pharmacists are able to extend their therapeutic reach to a larger patient population. "We can actually improve care directly and indirectly for more patients that way," Saseen said. "It's a win-win situation for patients because they get the most attention in this kind of model."
That kind of collaboration among healthcare providers is a key to managing therapy for diabetes patients, Saseen believes. But even in community practice, where collaboration is more difficult, pharmacists can make a difference for diabetes patients, he said.
"They may not have full disclosure of medical records and they may not have that tight working relationship with the providers," he noted, "but they do have access to the patients. They may not be able to prescribe under protocol and they may not be able to titrate medication as much, but they can help identify problems and intervene on problems."
They can also educate the public about the importance of lifestyle changes in preventing or delaying the development of diabetes and thus eliminating or minimizing an important cardiovascular risk factor.
A recent study found that even moderate weight loss brought about by diet and exercise can reduce the risk of developing diabetes. The five-- year study, sponsored by the National Institutes of Health, the American Diabetes Association, and other public and private groups, involved 3,000 volunteers who participated for an average of three years. Researchers discovered that even small dietary and exercise changes that resulted in weight loss reduced the risk of developing diabetes by 58%. The study also found that preventive treatment with metformin, the oral antihyperglycemic drug, lowered the risk of developing diabetes by 31%.
In a presentation at ASHP's recent annual meeting in Los Angeles, Saseen talked about the strong link between diabetes and cardiovascular disease and about strategies to reduce cardiovascular risk in patients with diabetes. Saseen, who teaches at the university's pharmacy school, said he tells his pharmacy students that "when we see a patient with Type 2 diabetes, that is a patient with opportunity, because chances are they're not optimally managed from many aspects. …