The role of the pharmacist in the management of type 2 diabetes: current insights and future directions

Integrated Pharmacy Research and Practice The role of the pharmacist in the management of type 2 diabetes: current insights and future directions Jeffer y David Hughes 2 Bruce Sunderland 2 Kreshnik Hoti 0 2 0 Department of Pharmacy, Faculty of Medicine, University of Prishtina , Prishtina, Kosovo 1 Centre for Medicines Information and Pharmaceutical Care (CMIPIC), Faculty of Pharmacy , Universitas Surabaya, Surabaya , Indonesia 2 School of Pharmacy, Curtin University , Perth, w A , Australia Type 2 diabetes is a chronic disease occurring in ever increasing numbers worldwide. It contributes significantly to the cost of health globally; however, its management remains in the most part less than optimal. Patients must be empowered to self-manage their disease, and they do this in partnership with health care professionals. Whilst the traditional role of the pharmacist has been centered around the supply of medicines and patient counseling, there is an evergrowing body of evidence that pharmacists, through a range of extended services, may contribute positively to the clinical and humanistic outcomes of those with diabetes. Further, these services can be delivered cost-effectively. This paper provides a review of the current evidence supporting the role of pharmacists in diabetes care, whilst providing a commentary of the future roles of pharmacists in this area. Diabetes mellitus (“diabetes”) is one of the fastest growing chronic diseases worldwide, and is associated with significant morbidity, mortality, and health care costs. Diabetes is characterized by high levels of glucose in the blood (hyperglycemia). There are three main types of diabetes: pharmacy; interventions; outcomes; benefits; glycemic control; cost-effectiveness - ldedao rpeoF open access to scientific and medical research Introduction • Type 1 diabetes mellitus (T1DM) in which there is an absolute deficiency in insulin production. This disease can occur at any age, although it mostly occurs in children and young adults.1 Type 2 diabetes mellitus (T2DM) which is associated with insulin resistance, with an initial increase in insulin secretion, however over time, beta cell death and insulin insufficiency. Although T2DM mainly occurs in people aged over 40 years old, the disease is also becoming increasingly prevalent in the younger age group.2,3 Gestational diabetes which occurs during pregnancy. The condition usually disappears once the baby is born; however, a history of gestational diabetes increases a woman’s risk of developing T2DM later in life.1 The statistics related to diabetes mellitus globally are alarming. The International Diabetes Federation (IDF) Diabetes Atlas, Seventh Edition, 2015, provides the following estimates: one in 11 adults have diabetes (416 million), nearly half (46.5%) of adults with diabetes are undiagnosed, one in seven births are affected by gestational diabetes, 542,000 children have type 1 diabetes, and a person dies from diabetes every 6 seconds.4 Further, the IDF estimates that by 2040, one in 10 adults (642 million) will have diabetes.4 Of those people with diabetes, three quarters (75%) live in low- and middle-income countries.4 The Western Pacific region (which includes Australia) has 37% of all adults living with diabetes. This includes 100 million people in the People’s Republic of China (ranked highest in number of people with 8 diabetes), 10 million people in Indonesia (seventh highest), l-201 and 7.2 million in Japan (ninth highest). Also included in this -J2u region is the country with the highest prevalence of diabetes 1n the Pacific Island nation of Tokelau where 30% of the adult 53o population has diabetes. Globally, Cambodia has the lowest .541 prevalence of diabetes at 3%.4 .532 T2DM is the greatest contributor to the burden of dia.51 betes globally accounting for up to 90% of people with /yb diabetes worldwide.4 Further, its prevalence is increasing in .com all countries around the world. This increase has paralleled rsse the global epidemic of obesity. It is estimated that since vpoe 1980 worldwide, obesity has nearly doubled. In 2008, it was .d estimated that there were 1.4 billion adults (35% of those //www l.yno 20 years or older) who were overweight, of which over half t:sp sue a billion (11%) were obese.5 Importantly, it is reported that thom lsaon being overweight or obese contributes significantly to the ldedao rpeoF cbeurrtdaeinn coafndciearbse(treasn(g4e47%%),–i4sc1h%e)m.5iYcehte,aorbtedsiistyeaissep(r2ev3e%n)ta,banled, fr r and strategies to prevent diabetes and cardiovascular disease both include the common goal to optimize peoples’ weight through diet and exercise. Adults with diabetes have a two- to threefold increased risk of suffering a heart attack or stroke compared to those without diabetes.6 The microvascular complications of diabetes mellitus make it the leading cause of preventable blindness, renal disease, and amputation in developed countries.6–8 These complica (...truncated)