DIABETES
DIABETES g
iven the ever-growing burden that diabetes places on our nation’s health and the
financial pressures it places on the nhS, it is of no surprise that there are increased efforts to improve the clinical management of - and to re- evaluate the efficacy and safety of treatments available - to those affected by the condition.
Diabetes mellitus is a condition caused by a lack of insulin or resistance to its action. The diagnosis is confirmed by the measurement of fasting or random blood glucose concentration, and in some cases by an oral glucose tolerance test. While many different subtypes of the condition exist, the two principle classes of diabetes of concern are Type 1 and Type 2 diabetes.
Type 1 (previously referred to insulin- dependent diabetes mellitus (IDDM)), is caused as a result of insulin deficiency following auto-immune destruction of pancreatic beta cells, thus Type 1 patients requires the administration of insulin for survival.
Type 2 diabetes (previously termed non-insulin-dependent diabetes (nIDDM)) is caused by a reduced secretion of insulin or to peripheral
14 - PhArMACy In foCUS
resistance of its action (in some rare cases a combination of the two).
While Type 2 patients can be controlled by diet alone, the majority require oral antidiabetic drugs or insulin (or both) to maintain adequate control. In patients who are overweight, Type 2 diabetes may be prevented by reducing their weight or increasing physical activity, and, in some circumstances, the use of orlistat (anti-obesity drug) may also be permitted in obese patients.
Within the UK it is estimated that nine out of ten adults currently diagnosed with diabetes suffer from Type 2 subtype, which is equivalent to around three million people. Type 2 is also more common in people of African, African Caribbean and South Asian family origin.
Pharmacists play a key role in the frontline support of diabetic patients, being the most appropriately qualified to advise patients on how to use medication to manage their condition. Additional support may be provided in the form of lifestyle recommendations and dietary interventions.
however, despite the pharmacist being a valuable, easily accessible
AS ThE InCIDEnCE of DIABETES ConTInUES To groW, PhArMACIST KUrTIS MoffATT ASSESSES ThE EnhAnCED rolE for ThE PhArMACIST In rEDUCIng ThE CoST To ThE nhS.
resource for this provision, a lack of public awareness means that patients and their carers are not taking full advantage of the services offered by their community pharmacist.
This is unfortunate, as it has been shown that the involvement of the pharmacist within diabetes management significantly improves adherence to treatment regimens. This is particularly important in Type 2 patients, as patient adherence to their prescribed treatment currently only stands at approximately 60 per cent.
given the poor adherence rates associated with Type 2, getting the right treatment and support to manage the condition is of utmost importance, as if blood glucose levels are not managed effectively (as with Type 1), it may lead to tissue damage, which can also result in blindness, kidney failure, and foot ulcers which may ultimately end in amputation.
Insulin may be incorporated with the therapy for Type 2 patients, who are poorly controlled by oral anti-diabetic medication alone. however, it is seen as an end-of-the-line option and presents a lot of drawbacks, such as a potential patient fear of injectables,
monitoring requirements and additional expenditure for the nhS.
however, in 2016, nICE recommended three new treatment options for treatment of Type 2 diabetes. The drug class - known as sodium glucose co-transporter 2 inhibitors (SglT2) - exert their action by reversibly inhibiting sodium glucose transporter two in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
It was estimated that 31,000 diabetics would be eligible for the recommended treatments: canagliflozin (Invokana), dapagliflozin (forxiga) and empagliflozin (Jardiance). The three drugs were licensed for use alone, or as part of combination therapy if a person can’t use metformin, sulphonylureas or pioglitazone, and diet and exercise alone isn’t controlling their blood glucose levels.
The use of these drugs helps control blood sugar levels in those patients who, for various reasons, cannot take the more commonly-prescribed medicines, and also avoids the use of insulin, thus giving Type 2 diabetics more management options.
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