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CHAPTER AIMS
The aims of this chapter are to:
Discuss the roles of a systematic patient care process and clinical reasoning in assessing and resolving medication-related problems as part of a collaborative effort to provide patient-centered care in type 2 diabetes mellitus (T2DM) management.
Incorporate the elements of the Pharmacists’ Patient Care Process (PPCP) in a simulated patient case while outlining critical thought processes and clinical reasoning as it relates to the care of a person with T2DM.
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KEY WORDS
• Type 2 diabetes • critical thinking • clinical reasoning • medication optimization • chronic disease state management • Pharmacists’ Patient Care Process • patient-centered care
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Providing care for patients with diabetes mellitus (DM) requires a multifactorial approach and is ideally conducted in an interdisciplinary practice. The World Health Organization describes diabetes as “a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.”1 The primary concern of the resultant hyperglycemia is the negative impact on nerves and blood vessels. These negative impacts result in chronic complications of diabetes, including microvascular complications (eg, retinopathy, nephropathy, neuropathy) and macrovascular complications (eg, transient ischemic attack, cerebral vascular accident, myocardial infarction).
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According to the American Diabetes Association (ADA), Standards of Medical Care in Diabetes 2023, the diagnosis of DM is made following a fasting plasma glucose (≥126 mg/dL), 2-hour oral glucose tolerance test (≥200 mg/dL following 75 g anhydrous glucose), random plasma glucose (≥200 mg/dL with classic symptoms of hyperglycemia such as polyuria, polydipsia, polyphagia), or A1C (≥6.5%).2 Confirmation of the diagnostic test is needed in the absence of unequivocal hyperglycemia.
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Over 37 million Americans have a diagnosis of diabetes, with about 90% having type 2 diabetes mellitus (T2DM). The cost of diabetes care in the United States has risen significantly in recent years, with a 26% increase between 2012 and 2017. In 2017, the estimated cost of diabetes was $327 billion (US dollars), with direct medical costs contributing $237 billion and reduced productivity contributing $90 billion.3
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Diabetes management requires active participation from the patient in many aspects of their lives, and accordingly, it requires healthcare providers to actively engage in the biopsychosocial model when applying a multifactorial approach to providing care to each patient. Therefore, the ADA recommends “people with diabetes can benefit from a coordinated multidisciplinary team that may include and is not limited to diabetes care and education specialists, primary care and subspecialty clinicians, nurses, registered dietitian nutritionists, exercise specialists, pharmacists, dentists, podiatrists, and mental health professionals.”4
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KEY POINT
Diabetes is a multifactorial disease state and requires a team approach to care. An interprofessional team is desirable to provide support needed by the patient, while keeping in mind that the patient ...