Empowering Patients Through Diabetes Education

RELEASE DATE

November 1, 2023

EXPIRATION DATE

November 30, 2025

FACULTY

Leticia A. Shea, PharmD, BCACP
Associate Professor
Regis University School of Pharmacy
Denver, Colorado

Micheline A. Goldwire, PharmD, MS, MA, BCPS
Professor and Director, Drug Information Services
Regis University School of Pharmacy
Denver, Colorado

FACULTY DISCLOSURE STATEMENTS

Drs. Shea and Goldwire have no actual or potential conflicts of interest in relation to this activity.

Postgraduate Healthcare Education, LLC does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced, objective, and scientifically rigorous. Occasionally, authors may express opinions that represent their own viewpoint. Conclusions drawn by participants should be derived from objective analysis of scientific data.

ACCREDITATION STATEMENT

acpePharmacy
Postgraduate Healthcare Education, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

UAN: 0430-0000-23-112-H01-P
Credits: 2.0 hours (0.20 ceu)
Type of Activity: Knowledge

TARGET AUDIENCE

This accredited activity is targeted to pharmacists. Estimated time to complete this activity is 120 minutes.

Exam processing and other inquiries to:
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DISCLAIMER

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

GOAL

To expand pharmacists’ understanding of patient education for type 2 diabetes (T2D) management and how to empower patients to manage their T2D.

OBJECTIVES

After completing this activity, the participant should be able to:

  1. Describe why diabetes self-management education and support is important.
  2. Define barriers to medication adherence for patients with T2D.
  3. Discuss approaches to increase adherence and foster a sense of empowerment in patients with T2D.
  4. Explain strategies to improve overall quality of life in patients with T2D.

ABSTRACT: A multifaceted approach is important for enhancing type 2 diabetes (T2D) outcomes. The implementation of a number of different strategies, including case management, patient education, and promotion of self-management, is effective across various health goals. Pharmacists play a pivotal role in addressing medication adherence and cost concerns, providing personalized care, and supporting T2D patients with comorbid depression. Patient empowerment and the establishment of collaborative goal setting are crucial. By actively engaging with patients who have T2D and equipping them with the knowledge and tools needed to achieve better health, pharmacists can foster a sense of empowerment in their patients and play a critical role in comprehensive T2D care.

Self-management support plays a pivotal role in the treatment and management of type 2 diabetes (T2D), offering patients the tools and knowledge needed to actively participate in their own care and achieve better health outcomes. Diabetes self-management education and support (DSMES) refers to the process by which patients with chronic conditions such as T2D take responsibility for their daily care activities, including medication adherence, dietary choices, physical activity, blood sugar monitoring, and stress management.1,2 This proactive engagement empowers patients to make informed decisions and adopt healthier lifestyles, leading to improved glycemic control, reduced complications, and enhanced overall quality of life (QOL).

BENEFITS OF SELF-MANAGEMENT

Research has consistently demonstrated the benefits of self-management support for patients with T2D. Patients who feel a sense of ownership and control over their condition are more likely to adhere to prescribed treatments and lifestyle modifications. This adherence, in turn, contributes to better blood sugar regulation and reduces the risk of T2D-related complications such as cardiovascular disease, neuropathy, and retinopathy. Results from studies show that DSMES provides a reduction of 0.45% to 0.57% in A1C compared with usual care.2

Furthermore, self-management support encourages personalized care plans tailored to each patient's unique needs, preferences, and circumstances. This individualized approach considers cultural factors, socioeconomic status, and psychosocial aspects, fostering a stronger patient-provider relationship and increasing the likelihood of sustained behavioral changes.2

Self-management support also has the potential to enhance patient self-efficacy and self-confidence in T2D management. By fostering the skills needed to self-monitor blood sugar, recognize symptoms of hyperglycemia or hypoglycemia, and make appropriate adjustments to their treatment regimen, pharmacists can help patients gain a sense of mastery over their condition. This empowerment may lead to improved self-esteem, reduced anxiety, and greater overall psychological well-being.2,3

HEALTH-LITERACY CONSIDERATIONS

Health literacy plays a pivotal role in medication adherence among patients with T2D. The ability to understand medication instructions, dosages, and potential side effects is essential for effectively managing this chronic condition. Limited health literacy can lead to confusion and misunderstandings, resulting in improper medication use and compromised glycemic control.4,5 Patients with low health literacy may struggle to interpret prescription labels, understand the timing and purpose of different medications, and communicate concerns to healthcare providers. Therefore, healthcare professionals must prioritize clear communication and patient education to bridge the health-literacy gap, empower patients to take medications correctly, and consequently improve T2D management outcomes.

Several strategies can be employed to enhance T2D education in patients of varying health-literacy levels. First, healthcare professionals should employ plain language, using clear and simple wording that is easy to understand.6 Visual aids such as diagrams or pictograms can further enhance comprehension. The use of metaphors can help bridge the gap between medical jargon and patients' everyday experiences.7 In addition, interactive and participatory approaches to education, such as group discussions and hands-on demonstrations, can promote active engagement and facilitate better understanding.2,4 Using the "teach-back" method improves health literacy.6 After educating patients on the glucometer, ask them to explain how they plan to use it. Begin by assuring that all essential points were covered, saying, "To ensure that I didn't miss anything, can you describe how you will use the glucometer, based on our discussion?"

PATIENT EMPOWERMENT

Patient empowerment is critical for appropriately managing T2D. Ensuring that patients participate in and take responsibility for their care in order to improve health outcomes and, secondarily, to reduce health costs forms an avenue for continual care.8 The American Diabetes Association recognizes the complexity of managing T2D and recommends that education and medication-taking behavior be reevaluated every 3 to 6 months.9 These appointments provide patients with support that helps counteract misinformation while also integrating their present lifestyle and circumstances into the process of education, discussions, and planning. It is essential for pharmacists to recognize the importance of fostering empowerment in patients.

Pharmacists serve as proactive problem solvers; still, it is essential that patients identify the issues at hand and, with the help of the pharmacist, formulate solutions that align with the patient's abilities and commitment to get healthy. Studies focusing on changing health behaviors and supporting patients in adopting healthier habits reveal that the manner in which patients are addressed can significantly impact their motivation to commit and take action.10 Motivational interviewing has demonstrated its efficacy in facilitating positive health changes across various settings, including patients with T2D.10,11 This type of interviewing is a learned skill, and mastery takes time and practice.

A key element of motivational interviewing linked to successful adoption of healthy behavioral changes is the initial step: building rapport with the patient.10,11 Rather than providing immediate solutions to problems, motivational interviewing involves determining the patient's motivation. For instance, a patient might express, "I understand I should take my medications, but I'm concerned about their potential long-term effects." While the pharmacist's inclination might be to elucidate the medication's benefits and emphasize better outcomes and reduced hospitalizations, motivational interviewing requires pharmacists to center their attention on the patient's perspective. Direct the patient's attention toward the positive aspects and reflect back what the patient is communicating during the conversation, using a statement such as: "You recognize the significance of adhering to your medications, yet you have reservations about potential side effects; am I understanding this correctly?" Motivational interviewing is about identifying the patient's motivation for better health.

PHARMACIST'S ROLE IN DIABETES EDUCATION

A comprehensive medication review for patients with T2D should include ensuring appropriate medication therapy to support A1C goals, decreasing blood pressure, lowering LDL to decrease cardiovascular events, reducing hospitalizations, lessening complications, and improving overall QOL. When performing a comprehensive medication review for patients with T2D, it is crucial to consider cardiovascular medications, including blood pressure-lowering drugs and statins, as well as medications for T2D. Furthermore, as a component of reviewing medications, adherence must be determined. Several of the more recent T2D medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors, offer cardiovascular and renal protection.12 However, these advantages remain unrealized if the patient is not adherent.

The management of T2D constitutes an ongoing continuum wherein the pharmacist assumes a pivotal role in assisting patients with their medication regimen and evaluating efficacy. Determining adherence involves a bit of detective work (FIGURE 1). Twenty years ago, it was estimated that approximately 50% of patients with chronic conditions took their medications as prescribed.13 A recent review evaluating adherence to oral antidiabetic drugs found similar results, with only 54% of patients considered to be adherent.14 Oral antidiabetic agents are generally the preference for patients with T2D. Given that adherence to oral T2D medications stands at 54%, the challenges associated with maintaining adherence to injectable treatments can be extrapolated.

An initial measure for assessing adherence involves verifying whether the patient obtains the prescribed medications from the pharmacy. However, this action contributes only a fragment to the overall assessment. When poor glucose control persists despite medications being taken as prescribed, a comprehensive investigation becomes imperative. Prescribing databases and prescription retrieval might underestimate patient nonadherence, however, as they indicate the acquisition of prescriptions by patients, not the actual consumption of the medication.15

Furthermore, the more complex the regimen, the more likely it is that nonadherence will occur.15,16 Therefore, when patients with T2D do not obtain the desired A1C goal with their currently prescribed medications, instead of immediately recommending an increase in dosage and/or additional medications, a thorough evaluation is prudent (FIGURE 2). Shared decision making is instrumental in supporting patients with T2D. Studies that evaluated adherence to T2D medications indicated that one intervention or one strategy will not be enough to support adherence.17 Irrespective of cost as a hindrance, other barriers, such as negative perceptions or apprehensions regarding potential side effects, should be evaluated. Addressing these hurdles to adherence often demands a multifaceted approach involving multiple interventions to facilitate resolution.15,17

Patients with T2D are less likely to take their medications as prescribed if they have negative beliefs about the medication.15,18 Starting or initiating new therapy to decrease high blood sugars may be associated with shame or a sense of failure.15,18 Pharmacists have a key responsibility to be attentive to and understand patients' perspectives on medication while also contributing to reducing any stigmatization linked to their prescriptions. Additionally, they can play a crucial role in imparting education about the advantages obtained from medication adherence.

Genetics substantially contributes to the onset of T2D. Studies focused on genetic associations have unveiled numerous T2D risk loci—positions on chromosomes housing genes or genetic markers—implicated in the disease's pathogenesis.19 Although lifestyle certainly has a role in the development of T2D, some patients are much more likely than others to develop T2D, regardless of lifestyle. Therefore, instead of medications being viewed as a punitive measure, they can be seen as agents that help restore equilibrium to a body experiencing dysfunction. Communicate to patients that their bodily mechanisms might pose challenges and that medications offer a pathway to reinforce their endeavors to achieve health objectives.

Overcoming Adverse Effects or Fears Thereof

When prescribed medications, patients might receive counseling solely on potential side effects (FIGURE 2). Instead of exclusively emphasizing potential side effects, offer a well-rounded perspective that highlights the medication's benefits while explaining the underlying reasons for possible side effects and strategies to mitigate them. In a study examining reasons for discontinuing GLP-1RAs, patients attributed discontinuation mainly to gastrointestinal side effects, whereas physicians primarily cited "insufficient blood glucose control" as the leading cause.20 This highlights a disconnect that can occur in communication surrounding the medication. Consider these two scenarios:

  • Scenario 1: "Your blood sugar is too high. We can start you on an injection therapy to lower your blood sugar. Unfortunately, this therapy can cause gastrointestinal upset such as nausea and vomiting."
  • Scenario 2: "Your blood sugar is higher than is healthy, so a medication that can help you lower your blood sugar while protecting your kidneys and heart is a good place to start. In addition to helping your T2D, heart, and kidneys, this medication will help you lose weight. Right now, your body is working against you. It's harder for you to lose weight than someone without T2D. This medication will help you lose weight and improve your blood sugar. In the beginning it may cause nausea or possibly even vomiting. We can start at a low dose to get your body used to the medication and increase the dose, as needed, slowly over time. This will help prevent you from experiencing severe gastrointestinal side effects, and they will go away over time."

Scenario 2 is likely to foster greater comfort among patients with T2D and cultivate a positive perception or belief in their therapy.

Following initiation of therapy, follow up with a phone call within a few days to 1 week (FIGURE 2). Reiterate the advantages of the medication and pay attention to the patient's responses to ascertain whether dose adjustments are needed. If phone follow-ups are not feasible, ensure in-person interaction when the patient picks up the medication. Because it is not a new medication, there is no set consultation schedule; it is the responsibility of the healthcare provider to prioritize these interactions. Keeping a record of specific questions can help guide these counseling sessions during medication pickup. For example:

  • Inquire about Mrs. Smith's gastrointestinal symptoms in response to her current metformin dosage.
  • Solicit Mrs. Smith's perspective on the progress of nausea while on her present GLP-1 dosage.
  • Request feedback from Mrs. Smith regarding whether adopting a dietary regimen of smaller, more frequent meals has ameliorated the symptoms she previously experienced with her GLP-1 therapy.

Promoting Self-Management Skills

Unfortunately, some of the best T2D medications also can cause side effects during therapy initiation or when therapy is titrated too quickly.21-24 For example, metformin is recommended first-line because it provides glucose-lowering benefits without weight gain and hypoglycemia risks and, as shown in the United Kingdom Prospective Diabetes Study, it decreases the risk of all-cause mortality, reduces T2D-related death, and resulted in a 32% reduction in T2D-related endpoints.21,22 Unfortunately, many patients are not adherent.25 Rather than setting up a patient for failure of metformin therapy, expectation education should be provided. Patients should expect that metformin may cause gastrointestinal side effects when therapy is initiated (FIGURE 3). They should understand that it is okay if they experience these side effects—these effects can be managed and should go away over time.21,22 For patients who are starting metformin or resuming it after an unsuccessful trial, consider these key counseling points to enhance the patient's successful treatment20,21 :

  • Remember to take metformin with food.
  • If gastrointestinal side effects are too bothersome, decrease the dose until side effects subside, then slowly increase to desired dose.
  • Metformin immediate-release (IR) can be started at 500 mg once daily with a meal, for 1 week. If gastrointestinal side effects occur after 1 week, switch to an extended-release (ER) formulation.
  • Following 1 week of 500 mg once daily, increase to 500 mg twice daily with meals. Titrate to desired daily dose of 2,000 mg by increasing the dose by 500 mg each week. Slow titration, as needed, if side effects become bothersome.
  • Metformin ER results in fewer gastrointestinal side effects compared with IR metformin.
  • The 500-mg ER formulation costs less than the 1,000-mg ER formulation. (For patients receiving the 1,000-mg ER tablet twice daily who report cost as a barrier, check cost of two 500-mg ER tablets twice daily.)

In a study evaluating adherence to T2D medications, GLP-1RA injection therapies exhibited adherence in less than half of the participants.15 The most common reasons reported by patients for discontinuing GLP-1RAs were nausea and vomiting.15,20 Although nausea and vomiting are common with these therapies, self-management strategies minimize the severity. A strategy to manage GLP-1RA side effects includes a step-by-step approach termed "the 3 E's"23 : Education and explanation, Escalation to the appropriate dose, and Effective management of side effects (FIGURE 4). Explanations of self-management skills specific to GLP-1RA therapy should include these points23,24 :

  • Start at the lowest injection dose available. Allow your body time to adjust.
  • Eat slowly and stop when full.
  • Avoid high-fat and spicy foods.
  • Limit or avoid alcohol intake.
  • Avoid lying down after eating. Wait 2-3 hours before lying down.
  • Increase physical activity, but avoid high-intensity activity after eating.
  • Drink plenty of water, but separate large amounts of water from food intake by 20-30 minutes.
  • Avoid drinking with a straw.
  • Eat smaller, more frequent meals.

Clinical recommendations to prevent and manage side effects of GLP-1RAs include specific directives for addressing common side effects, such as nausea, vomiting, diarrhea, and constipation.24 Consuming crackers and/or apples 30 minutes after taking the GLP-1RA may alleviate nausea; for vomiting, it is recommended to increase hydration and consume smaller, more frequent meals. Given the complexity of T2D management, information overload is possible, so it is important to listen to patients, understand their side effects, and provide tailored actionable suggestions.

Comorbid Depression

It may not be widely recognized that depression is another consistent predictor of T2D medication adherence.25 Patients who have comorbid T2D and depression tend to exhibit greater nonadherence to treatment regimens compared with those with T2D alone.25,26 Importantly, a study of patients with both T2D and depression showed improvements in glycemic control when patients received adequate antidepressant therapy (defined as antidepressant treatment >12 months).27 This is not to suggest that antidepressant therapy is the sole solution for patients with T2D and comorbid depression. However, it is an area wherein pharmacists can play an active role in providing support.

Pharmacists may not always feel comfortable recommending behavioral therapy or know how to suggest such strategies. In community settings, pharmacists can inquire about the well-being of patients taking antidepressant medication. Furthermore, pharmacists should communicate with the prescriber if a patient is not responding well to the antidepressant medication. Pharmacists are well positioned to recommend alternative therapies, but it is inappropriate to do so without first communicating with the prescriber.

Just as T2D medications and their side effects require attention and counseling, antidepressant medications demand a similar approach. The overcoming of adherence barriers applies to both antidepressants and T2D medications. Instead of dismissing depression as something beyond their scope, pharmacists should consider depression a critical aspect of the care they provide. Awareness of a patient's mental-health status can influence the focus of care. Therefore, if depression is present or is identified as uncontrolled, it should be addressed as a component of the patient's T2D care.

The Patient Health Questionnaire-9 (PHQ-9) is an evidence-based tool readily available to any clinician that is used to assess patients for the presence, monitoring, and severity of depression.28 For patients diagnosed with T2D and depression, incorporating the PHQ-9 into the evaluation of current health status and ongoing monitoring can provide valuable insights. Pharmacists can administer and quickly score this patient-completed questionnaire. Sharing these results with the patient's primary care provider can initiate the necessary communication to support mental health and, indirectly, T2D care.

If a patient's depression is not well controlled, as evidenced by the PHQ-9 score, share the results with the primary care provider. Discuss with these patients the importance of antidepressants to their overall health, including T2D. For patients already on an antidepressant, ensure that they are taking it as prescribed and help them work through any adherence barriers, as described above.

Cost

A negative aspect of the newer T2D medications is the higher cost. There are several steps that can be taken to help minimize patients' out-of-pocket costs. Many prescriptions are written for 90 days, which is beneficial for promoting adherence, but as this may increase the cost at the time of pickup, it may be prohibitory for some patients. If a patient is struggling to pay for a 90-day supply, filling for 30 days may be reasonable. Pharmaceutical drug-savings cards may be available for patients with private insurance (not Medicare); for an uninsured patient, a patient assistance program (PAP) may be an option.

Drug-Savings Cards: Pharmaceutical companies often provide drug-savings cards, which are also available online (TABLE 1). Some cards require activation, whereas others are ready to use immediately. The activation process is simple, with patients entering their information or acknowledging their need for the card; once activated, the card functions like health insurance. Being familiar with obtaining these cards can streamline the process, and instructions for pharmacists on card use are available. Some cards are valid for a year, and others cover only one prescription. For instance, Ozempic's card is per prescription, with a new card needed each time; for refills, coverage continues once the card is replaced. Trulicity's card can be used for up to a year, depending on program initiation. If the out-of-pocket cost remains high after the card is run, obtaining a new card might resolve the issue.

PAPs: PAPs can be daunting, especially for older adults who may not be tech-savvy. To support patients in obtaining necessary, albeit expensive, medications for better health, it is crucial to understand PAPs. PAPs offer medications at no cost, resulting in improved health outcomes for patients. However, the process involves multiple steps and enrollment in the program must be renewed annually. PAP medications are not dispensed at the pharmacy, making pharmacist involvement essential to ensure complete medication management.

To apply for a PAP, several forms require completion. The patient completes a specific form to prove that eligibility criteria are met, including providing income details. Next, the prescriber completes a form detailing the medication and dosage. Some PAPs require the form to be emailed to the prescriber, whereas others allow it to be faxed after the patient completes the necessary information. The completed paperwork, including the patient form, income proof, medication details, and prescriber's signature, should be faxed to the PAP's provided number. To streamline the process, follow these steps:

  1. Have the technician or intern inform the prescriber that you are assisting a patient in starting the PAP application process. Advise the prescriber to anticipate a fax containing a partially completed form for the patient.
  2. Prepare the form in advance for the patient's visit by either filling in the available information from the medication records or completing the form with the patient. This approach reduces the patient's form-filling burden, as the patient can simply review the filled-in details (e.g., name, birthdate, address, Medicare type) and complete the few remaining sections, such as annual income and signature.
  3. Make a copy of the form and the patient's proof of annual income. Keep these copies in case the form is lost or is not received by the prescriber's office.
  4. Complete the provider form as comprehensively as possible (e.g., name, office address, PAP medication, dose, frequency). This simplifies the process for the prescriber, who can review the document and sign it. The prescriber should then fax both completed forms and the patient's proof of annual income to the PAP's designated fax number.

Promoting Self-Monitoring

Most of the evidence supporting the use of blood glucose monitoring surrounds insulin therapy, but it is also valuable for patient engagement by helping patients understand their body's response to food and daily activities. Start by educating patients about the meaning of current blood glucose values, which reflect the moment and not long-term trends. For those who are seeking insight into a "healthy diet," monitoring blood sugar 2 hours after meals for 1 to 2 weeks reveals how food impacts glucose concentrations.2

Patients should understand how their A1C concentrations influence the perception of "high" and "low" blood sugar symptoms. In those with a high A1C (e.g., 12%), "low" symptoms may occur at higher blood sugar concentrations (>70 mg/dL) than in those with a lower A1C (e.g., 8%).29 In patients with long-standing poor glycemic control, it is important to start at their current status and aim for gradual blood sugar reduction.30 Attainable goals are crucial; for example, an A1C of 12% corresponds to an average blood sugar of around 300 mg/ dL, so considering a fasting glucose of 150 mg/dL as "high" initially is unrealistic. Progress should target a fasting blood glucose between 80 mg/dL and 130 mg/dL, with the recognition that achieving 150 mg/ dL from an initial 300 mg/dL indicates improvement.29,30 When blood glucose monitoring is initiated, it is essential to introduce the process without pressure, using a patient-centered approach that considers individual needs, social determinants of health, literacy, and culture.2 The primary focus should be on engaging the patient in self-monitoring, with goals tailored to their progress.2

Sit down with patients and instruct them on how to use the blood glucose meter (BGM). Note that insurance may not always cover BGM costs, particularly for noninsulin users. Assess the meter's efficacy, as some perform better than others.31 If the meter readings do not align with the A1C, crosscheck with another meter.

Introduction of blood glucose monitoring to patients with T2D who are not on mealtime insulin should include these steps29,32 :

  1. Ensure that the monitor functions with proper batteries.
  2. Have the patient choose a notebook or calendar to record blood sugar values and foods eaten or activities that may impact the reading.
  3. Establish a plan with the patient for a 1- to 2-week blood sugar monitoring period.
  4. Schedule a follow-up date.
  5. Wash the hands with soap and water.
  6. Prepare the lancing device and set it aside.
  7. Have a test strip ready for use.
  8. Instruct the patient to swipe the chosen finger with an alcohol pad.
  9. Allow the area to dry.
  10. Demonstrate finger pressure to encourage blood flow.
  11. Position the lancet device slightly off-center on the finger pad.
  12. Activate the lancet and then collect the blood on the test strip.
  13. Insert the test strip into the device; results will appear quickly.
  14. Instruct the patient to record results (i.e., blood glucose values and fasting, premeal, or postmeal status). For postmeal readings, note the time elapsed since the last meal and specify the meal consumed, to understand food's impact on blood sugar.

Collaborating With Patients on Goals and Action Plans

Collaboration with patients once they begin blood glucose monitoring is a valuable approach for supporting their T2D journey. Meet with them after 1 to 2 weeks of monitoring to assess their T2D management, considering medications, diet, and lifestyle. Acknowledge improvements and identify instances of high blood sugar concentrations. Create a tailored action plan. In patients who are far from evidence-based goals (A1C <7%, fasting glucose 80-130 mg/dL, post meal <180 mg/dL), consider setting more achievable targets initially, with a follow-up in 2 weeks to assess progress toward improved outcomes.2 Develop action items for high blood sugar values, such as taking walks or using an online video for yoga or tai chi (or exercise of patient's choice), to achieve a 10- to 20-minute increase in activity. For online videos, find an exercise video that the patient deems likely to use. Patients should get active, even if only for 5 minutes. Create a plan for low blood sugar by identifying the patient's treatment preference, whether glucose tabs, orange juice, or candies. Emphasize the importance of quick sugar intake followed 15 or 20 minutes later by a carbohydrate-and-protein snack (e.g., cheese and fruit). Finally, schedule the next follow-up visit to ensure continued support for the established goals.

Evaluating the Impact of Diabetes Education

Pharmacist-delivered T2D education offers numerous benefits, including better medication adherence, improved blood glucose control, reduced hospitalization rates, and lower medical expenses.26 Pharmacists are equipped to offer evidence-based education, manage medication side effects, address cost barriers, and identify necessary medication changes based on patient labs and presentation. Pharmacists should consider the following measures to assess the impact of services in their pharmacy or clinic:

  • QOL: Assess at baseline and monitor annually or biannually using the World Health Organization's QOL survey.33
  • Objective measures: Track A1C and blood pressure, easily obtainable in the pharmacy. Consider point-of-care lipid analysis, if available, for added patient benefit.
  • Patient satisfaction: Use patient-satisfaction surveys designed for pharmacist-patient interactions. One example is a survey published in The Canadian Journal of Hospital Pharmacy.34

CONCLUSION

Patient self-care is at the heart of effective T2D management. By adopting a multifaceted approach that empowers patients through education, self-monitoring, and goal setting, pharmacists can significantly improve T2D outcomes. This approach not only addresses medication adherence and cost-related challenges but also recognizes the vital role of mental health in T2D care. In actively engaging with patients and supporting them in taking ownership of their health, pharmacists pave the way for enhanced well-being and a reduced risk of long-term complications. Patient-centered care and self-management support are the cornerstones of successful T2D management.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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