DIABETES The contribution a pharmacist can make
The contribution that pharmacists and their teams can make to the care of diabetic patients is well established. By focusing on five key points in the patient’s journey it may have numerous benefits, such as maximising the potential from their therapy, alleviating symptoms and minimising the risk of long- term complications:
1. Prevention – As with most things, prevention is always better than cure, and so pharmacy teams can help to identify individuals at risk of developing diabetes (weight, family history, race, age, etc.) and offer them appropriate intervention.
2. Identification and diagnosis - early diagnosis of diabetes can significantly reduce the risk of developing complications, as it allows people to receive the support they need to manage their condition. Again,
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Over the last few years, however, doctors had noticed that some obese patients, who went on to lose a lot of weight, saw their blood sugar levels drop back to normal and, more importantly, remain at that low level without diabetes medicines. This evidence fuelled interest in the concept of ‘reversing’ diabetes through major weight loss.
The DiRECT programme As a result of these observations, Diabetes UK committed £2.8 million to their Diabetes Remission Clinical Trial programme, known as DiReCT.
In the first twelve months, almost half of the 300 participants (45.6 per cent) were in remission of Type 2 diabetes. The programme involves a low- calorie, nutrient-complete, liquid diet.
After three to five months, food is then reintroduced and those taking part provided with long-term support to maintain their weight loss.
The study found that there was a close link between remission and total weight loss. eighty-six per cent of those, who lost more than fifteen kilogrammes on the programme, put their Type 2 diabetes into remission, as did 57 per cent of those, who lost between ten and fifteen
58 - PHARMACY IN FOCUs
community pharmacy has an opportunity to proactively identify people with diabetes within the community setting with appropriate onward referral to the GP and other healthcare professionals, where appropriate.
3. Initial assessment and management - Patient education is a valuable area in which pharmacists can become involve since, if people are aware of the implications of having diabetes, it will empower them to take control of their condition. Patients should be advised on management of the condition, the complications and the impact on lifestyle.
4. Ongoing care - While remarkable progress has been made in the pharmacological management of diabetes – such as the research discussed on these pages – issues such as lifestyle and
kilogrammes, and 34 per cent of those who lost between five and ten kilogrammes. In the comparison group, where people with Type 2 diabetes received standard care, only four per cent achieved remission.
New medicine gains approval european Medicines Agency’s human medicines committee, the Committee for Medicinal Products for Human Use (CHMP) has recommended granting a marketing authorisation in the european Union for Rybelsus (semaglutide) for the treatment of adults with insufficiently controlled Type 2 diabetes to improve glycaemic control as an adjunct to diet and exercise.
It is the first glucagon-like peptide
(GLP-1) receptor agonist treatment - a class of non-insulin medicines for people with Type 2 diabetes - developed for oral use, providing patients with another option to treat the disease without injections.
The active substance in Rybelsus, semaglutide, acts in the same way as the incretin hormone GLP1: it reduces blood glucose by stimulating pancreatic secretion of insulin and lowering the secretion of glucagon (a hormone that works to raise blood
patient education cannot be overlooked, as weight loss remains a crucial factor in improvement of condition and reduction in risk of complications.
5. Preventing or delaying complications - Pharmacists can contribute to the appropriate management of complications, and the risk factors for complications. Optimal glycaemic control in both Type 1 diabetes and Type 2 diabetes reduces, in the long term, the risk of microvascular complications, including retinopathy, development of proteinuria and neuropathy.
effective monitoring and understanding how to alter dietary and insulin requirements based on the results can have an impact on reducing diabetic complications.
Many patients now monitor their own blood-glucose concentrations
sugar concentration) when blood sugar is high.
The safety and efficacy of Rybelsus were studied in eight clinical trials that included patients at various stages of the disease. The most common side effects observed were gastrointestinal side effects, such as
and since blood-glucose concentration varies substantially throughout the day, ‘normoglycaemia’ cannot always be achieved on a daily basis without causing damaging hypoglycaemia.
It is therefore best to recommend that patients should maintain a blood-glucose concentration of between 4 and 9 mmol/litre for most of the time (4–7 mmol/litre pre-prandial and less than 9 mmol/litre post-prandial), while accepting that at various times, it will be above these values; however, the patient should be aware of the dangers of blood- glucose falling below 4mmol/litre, and make a strong effort to avoid this. Patients using multiple injection regimens should also understand how to adjust their insulin dose according to their carbohydrate intake.
nausea and diarrhoea. Hypoglycaemia may also occur when used in combination with insulin or sulphonylurea.
The CHMP opinion will now be sent to the european Commission for the adoption of a decision on an eU-wide marketing authorisation.
AI can detect low-glucose levels via ECG without fingerprick test
Tracking sugar in the blood is crucial for diabetic patients. Current methods to measure glucose requires needles and repeated fingerpricks over the day. Fingerpricks can often be painful, deterring patient compliance.
A new technology for detecting low glucose levels via eCG using a non- invasive wearable sensor, which with the latest Artificial Intelligence can detect hypoglycaemic events from raw eCG signals has been made by researchers from the University of Warwick.
The new technique, which has been developed by researchers at the University of Warwick uses the latest findings of AI to detect hypoglycaemic events from raw eCG signals via wearable sensors. The technology works with an 82 per cent reliability and could replace the need for invasive finger- prick testing with a needle, which could be particularly useful for paediatric age patients.
‘Fingerpricks are never pleasant,’ said Dr Leandro Pecchia from the school of engineering at the University of Warwick, ‘and in some circumstances are particularly cumbersome. Taking a fingerprick during the night certainly is unpleasant, especially for patients of paediatric age.
‘Our innovation consisted in using artificial intelligence for automatic detecting hypoglycaemia via few eCG beats. This is relevant because eCG can be detected in any circumstance, including sleeping.’
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