DIABETES
DEALING WITH
f all the metabolic diseases that pharmacists encounter, diabetes must surely be one of the
DIABETES O
most common. Due to the nature of the disease, its variant types, and its prevalence, pharmacists should have a thorough understanding of target diagnostic levels, specifi c treatments, and lifestyle measures that can be utilised by the patient to ensure that they can appropriately manage their condition and prevent complications in the long term.
THE CONDITION
As with many conditions within the realm of the community pharmacist, diabetes as a condition, and moreover, as two distinct conditions, is often well understood from the aspect of the pharmacist, but not well understood from the viewpoint of the patient. This can lead to the construction of a roadblock between patient and pharmacist, which may prevent adherence to treatment regimens, ignorance of lifestyle advice, and failure of patients to understand the severity of the condition with which they have been diagnosed. This can be attributed to, at least in part, the pharmacist, and an explanation of these factors to the patient in terms which are often overly-clinical. As a result, pharmacists should strive to ensure that they can explain what diabetes is, and more specifi cally, what diabetes is in terms of the type which that particular patient has been diagnosed with.
In general, and in simplistic terms, diabetes (diabetes mellitus is commonly referred to as diabetes, and not to be confused with diabetes insipidus) can be described as complex condition where the amount of sugar (in the form of glucose) in the blood is too high, because the body cannot process it correctly. Whilst
40 - SCOTTISH PHARMACIST
this may indeed seem very simplistic from the viewpoint of a highly trained healthcare professional, it is recommended that a pharmacist can distil such a complex condition down to a defi nition like this, in order to maintain patient engagement and ensure that the patient can gather the correct degree of information. With regard to the differentiation between Type 1 (T1) and Type 2 (T2) diabetes, the following analogy (or any variation thereof as the pharmacist sees fi t) could be used:
• Glucose needs to enter our cells in order to give us energy
• Insulin, normally produced from within our bodies, is the key which unlocks the cell and allows glucose to enter
• In T1 diabetes, no insulin is made in the body, leaving the cells “locked” and preventing glucose from entering
• In T2 diabetes, the “lock” to the cell or the insulin “key” are broken, insulin no longer fi ts into the “keyhole”, and again glucose is prevented from entering into the cell, hindering energy utilisation.
Of course, we pharmacists know that the pathophysiology of the condition is much more complex than this, but it is vital that we can communicate the nature of the condition in simple terms (and leading on from this, the severity of the condition) to our patients, as this will undoubtedly lead to the improvement of patient outcomes, and willingness to adhere to treatments and advice.
THE EXTENT OF THE PROBLEM So, why should we focus on health promotion with patients with diabetes anyway? Apart from the fact that diabetes of any type can be potentially
very serious, and even fatal if left uncontrolled, the prevalence of diabetes in Scotland is a major issue, and set to become even more so, in line with epidemics such as obesity which also plague the country. Thus, a greater degree of understanding of target levels, treatments, and appropriate lifestyle advice may lead to a greater percentage of patients who have their condition under control, and targeted health promotion at an early stage may lead to a reduction in those who are diagnosed with T2 diabetes in later life.
In 2013, NHS Scotland found that there were approx. 270,000 patients diagnosed with diabetes living in the country, over 5% of the population. This was an increase on the previous year’s statistic of around 260,000 people, approximate to 4.8% of the population. This increase in prevalence was explained by a number of factors, including demographic change of the country (as the population ages, so will the prevalence of T2 diabetes), an increase in T1 diabetes within Scottish children (a trend which has persisted over the last 40 years), better survival due to improved monitoring and associated treatments, and improved detection of T2 diabetes in patients who may normally not have been tested due to a lack of symptoms1,2
. In addition to this, the
increase of prevalence of T2 diabetes within younger people in Scotland is currently being investigated, which is particularly troublesome as these patients will suffer from the condition
long enough for complications such as renal failure, and others, to develop.
These top-line numbers express the extent of the problem of diabetes within the Scottish borders, and will hopefully renew the urgency with which this disease is tackled. As always, pharmacists lie at the heart of this process, and are heavily involved in both the prevention of development of the condition, in addition to the facilitation of patients in exquisitely controlling their blood-glucose levels, preventing the occurrence of long- term complications.
TESTING THE LEVELS
A critical factor for both the diagnosis and the monitoring of diabetes control is unsurprisingly, the blood-glucose level. However, according to the recommendations of the WHO, the analysis of immediate blood-glucose levels differ depending on the patient’s symptom state. In addition, the use of more sophisticated blood testing should be used to provide more reliable results.
For example, the WHO state that under no circumstances should a diagnosis of diabetes be given after a single blood-glucose determination. If this is the case, at least one other blood-glucose test, taken on another day, which is in the diabetic range is essential for diagnosis. However, even if this is the case, confi rmatory plasma venous determination should be used to confi rm the patient’s condition. In a situation where the patient exhibits other diabetic symptoms (polydipsia,
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