In part 4 of this Exclusive Interview, Keith Campbell explains determining the proper combination of medications in a conversation with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California.
Having been an instrumental change in the way pharmacists practice pharmacy, Professor Emeritus R. Keith Campbell, RPh, MBA, CDE, FASHP, FAPhA, FAADE, is the former Associate Dean and Distinguished Professor in Diabetes Care/Pharmacotherapy at the Washington State University College of Pharmacy in Pullman, Washington.
Transcript of this video segment:
Steve Freed: When you first started, you were educating medical professionals because you were a professor. You talked about diabetes, which is your passion. It was pretty straightforward. You had one drug, which was sulfonylureas as I mentioned before, but now we have over, probably if you figured it out if you include insulin possible combinations, it’s probably over a million possible combinations. So, what do you teach or what did you teach towards the end? How do you determine which drug or which combination of drugs…You can go through trial through a person’s lifetime and changing it every 30 to 60 days before you find the right one. What is the best way to determine if it’s a combination type of thing?
Keith Campbell: Well, in the first edition of Medications for the Treatment of Diabetes, I had a chapter on an algorithm and what was fun about that, because I didn’t see that anyone else was working on algorithms, is here’s the things you have to know about the patient before you decide what you’re going to use. There’s probably 15 or more things you need to know about the patient: what does their insurance allow is a big barrier and if they don’t have insurance what can they afford; what’s their kidney function and what’s their liver function; what are their fat levels in their blood; what’s their blood pressure; what medications have they tried before that worked or didn’t work; and in what doses. When you go through all of that, you can then individualize the treatment for each patient. About 10 years ago, the ADA started promoting individualization because there’s no two patients exactly alike. I thought that was a tremendous movement to move in that direction and when you do that you can come down with most type 2 patients. I’m a huge fan of Ralph DeFronzo and so you know some metformin, SGLT-2 inhibitor, and maybe a GLP-1 agonist or a DPP-4 inhibitor, depending on what the patients are willing to do. Are they monitoring and have they take charge of their own diabetes and have they been educated? So, it’s really frustrating, if you are health care provider, when you see the new insulin and then you see the combination of the new insulin with other things, then the combination with those and what studies have been out there. The last 5 years I get calls all the time. “What do we do here?” This is overwhelming as to what’s going on and you said you could have a million different choices as to what to do. Some of the companies do a phenomenal job with educational materials for patients. I know some of the Novo Nordisk educators and then you have medical science liaisons and they helped train the expert, you know, the endocrinologist and they help get the word out as to how they’re treating, so if you really look into the literature and you pay attention and there’s a site that you might want to know about. It’s called website called Diabetes in Control and I’m not being funny here. It is a phenomenal website. I’m so proud of you and David and what you have done there. I hear from people all the time. They go to that. They’re on twice a week and they have all kinds of things. It really help motivate people and give them some confidence to feel up to date and to know what’s happening and what new things are coming down the pike and I like the ADA site and I like the AADE’s site. There’s some really good information out there. As everyone know, we Google whatever it is. So, the key is to having the patient be excited about taking care of their diabetes and there’s a lot of people in denial, there’s a lot of people that are angry, there’s ways to confront the patient in a positive way and get them to overcome them.
Steve Freed: I have to say you’re in good company. We have two of your favorite people were here yesterday. Ralph DeFronzo was here. Steve Edelman was here. So, you are in good company. We only invited the smartest people and you have been here a few times.