The Role of Pharmacists in Diabetes Education

Pharmacists in the community setting play a role in diabetes screening and management by providing direct patient care.

With the constant increase in the prevalence of diabetes, education is vital in understanding how to control disease progression. Pharmacists play an essential role in disease management, assessing medication adherence, and educating patients on lifestyle habits. A study conducted in 2018 revealed that the addition of pharmacists to diabetes care teams improved patient health and prevented increased costs and complications¹. Pharmacists can speak on their recommendations utilizing evidence to support. There are constantly new diabetes medications that primarily work in the same way, which is why pharmacists can play a role in selecting medications while maximizing efficacy, prevent further complications, benefit concurrent diseases, and reducing adverse events. Understanding risk vs. benefit and cost-effectiveness when recommending a particular medication is also something pharmacists have much experience with.

A previous trial conducted in 2015 known as GLICEMIA found that pharmacy intervention can lead to a significant reduction in the risk of diabetes; however, it did not reduce the rate of diabetes progression over one year². GLICEMIA 2.0 was a multicenter, cluster-randomized controlled trial³ conducted in 26 German pharmacies to examine if intensive pharmacist intervention in community pharmacies can effectively improve glycemic control in patients with type 2 diabetes. 198 study participants were recruited, with 86 participants in the control group and 96 in the intervention group. All pharmacists were trained one day before the start of the trial. Pharmacists in the intervention group received an additional day of training which consisted of medication analysis and patient counseling. Participants in the intervention group were followed for one year, and such intervention was implemented by monthly telephone calls, three personal counseling sessions, and six group meetings. The control group received education in writing as well as the usual standard of care. Patients were included if they had an HbA1c ≥7% and a BMI of at least 25 kg/m2. Data such as HbA1c, fasting blood glucose levels, weight, and blood pressure were collected at baseline and after 6 and 12 months. The primary outcome was the change of HbA1c within the study year. Secondary outcomes changes in fasting blood glucose levels, weight, and blood pressure. Intention-to-treat analysis was used, and linear mixed-effects models analyzed the outcomes.

The control group had reduced HbA1c, mean ± SE 8.1 ± 0.1% (65 mmol) to 7.8 ± 0.1% (62 mmol), while the intervention group had a reduction from 8.3 ± 0.1% (67 mmol) to 7.3 ± 0.1% (56 mmol). The linear mixed-effects model showed a statistically significant difference in the intervention group (p<0.0001) as compared to the control group (p=0.1454). 9.3% of patients in the control group reduced their weight by at least 5%, compared to 26.9% in the intervention group. The researchers found no significant difference in the reduction of fasting blood glucose or blood pressure in either group.

The GLICEMIA 2.0 trial is one of its kind as there have not been many randomized controlled trials related to diabetes management among pharmacists in the community setting. These results showed a significant reduction in HbA1c and weight within 1 study year and with interventions compared to the control group. However, this study did not show a difference in reducing fasting blood glucose or blood pressure. In addition, this study lacks follow-up monitoring, which could help determine adverse events to certain medications or overall patient outcomes and satisfaction. Future studies should be done to evaluate the reduction of HbA1c in patients according to pharmacist interventions in other countries such as the U.S, as this study was only done in German pharmacies. It would also be interesting to note patients of different weights, rather than only analyzing patients with a BMI of at least 25 kg/m2 or greater. Diabetes places individuals at an increased risk for cardiovascular disease, kidney failure, vision loss, and amputation of the lower extremities. Pharmacists play an essential role in educating patients on medication adherence, which can help reduce mortality risk and complications.

Practice Pearls:

• The number of treatment options for patients with diabetes increases over the years, which is why pharmacists can help patients understand which medications are best intended for them.
• The GLICEMIA 2.0 trial showed a significant reduction in HbA1c and weight in the group where pharmacists directly intervened and followed patients for one year.
• Pharmacist intervention can help minimize complications of uncontrolled diabetes and improve quality of life.

1. Benedict, Amanda W et al. “Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System.” Journal of managed care & specialty pharmacy
2. Schmiedel, Karin et al. “Effects of the lifestyle intervention program GLICEMIA in people at risk for type 2 diabetes: a cluster-randomized controlled trial.” Diabetes care
3. Prax, Katja et al. “Preventive Care in Type 2 Diabetes: Results of a Randomized, Controlled Trial in Community Pharmacies.” Diabetes care

Dalia Elabed, PharmD Candidate 2022, University of South Florida Taneja College of Pharmacy