After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:
Recognize the role of pharmacists in diabetes management services.
Review the goals of diabetes management.
Identify key concepts in diabetes management.
Discuss ways to prepare for clinic initiation.
Identify aspects to consider when developing a business plan.
Discuss clinic design.
Diabetes is a devastating disease affecting nearly 25.8 million people, which corresponds to roughly 8.3% of the U.S. population.1 Of the 25.8 million affected, it is estimated that nearly 7 million are undiagnosed.1 In 2007, diabetes was labeled the 7th leading cause of death based on death certificates, which was likely underreported as a primary cause of death.1 Overall, the risk of death is doubled for patients with diabetes compared with those without.1 Complications resulting from diabetes may include heart disease, stroke, blindness, kidney disease, amputations, dental disease, and pregnancy complications.1 Notably, diabetes is the leading cause of new cases of blindness in adults 20–74 years of age, accounts for 44% of all new cases of kidney failure, and is the cause of >60% of nontraumatic lower-extremity amputations.1 According to a national survey in 2007–2009, Puerto Ricans, Mexican Americans, non-Hispanic blacks, and Hispanic/Latinos age 20 years or older comprised the highest percentage of the population with diabetes (13.8%, 13.3%, 12.6%, and 11.8%, respectively).1 Non-Hispanic whites made up 7.1%, while Cuban Americans and Central and South Americans each made up 7.6% of the population of patients over 20 years of age with diabetes.1 The increased prevalence in minority populations may be due to genetic factors, lower income status, or lack of access to health-care. Community pharmacist-delivered pharmaceutical care is one way to help address this disparity and increase access to care for some of these patients.
The total cost of diabetes was estimated in 2007 to be at least $174 billion, with $27 billion used to treat diabetes directly, $58 billion to treat chronic complications related to diabetes, $31 billion in excess medical costs, and $58 billion accounting for reduced national productivity.2 On average about $1 in $5 health-care dollars was spent caring for someone with diabetes, while $1 in $10 health-care dollars was attributed directly to diabetes.2 The average annual expenditures attributed to the disease were estimated at $6649 in 2007.2
When diabetes is uncontrolled there is a greater likelihood of a rise in complications, which in turn can lead to increases in costs. The United Kingdom Prospective Diabetes Study (UKPDS 35), which was reported in 2000, found a reduced incidence of microvascular complications (including neuropathy, nephropathy, and retinopathy) in patients with type 2 diabetes that achieved intensive glycemic control.3 For every 1% decrease in mean hemoglobin A1C (A1C), there was an associated 37% reduction in risk of microvascular complications, 14% reduction in risk of myocardial infarction, and 21% reduction in risk of any end ...