Clinical Pharmacist role and their Importance in the Systematic Analysis of Diabetes Management Studies

 

Sini T. Inasu*, M.V. Kumudavalli, B.S. Venkateswarlu

¹Assistant Professor, Department of Pharmacy Practice, Ahalia School of Pharmacy, Palakkad, Kerala- 678557, India.

²MV. Kumudavalli, Professor, Department of Pharmacy, Vinayaka Missions College of Pharmacy,

Vinayaka Mission’s Research Foundation (Deemed University) Salem, Tamil Nadu- 636008, India.

 

ABSTRACT:

Pharmacy practice has moved from medication delivery to a patient-focused approach during the last four decades. The pharmacist role has shifted from a compounding pharmacist and distributor of pharmaceuticals to one of the services and finally to a care provider. Progressively, the pharmacist's job is to ensure that the patient's medication is adequate and the best possible and readily available. Pharmacists can depend on the personal needs of their patients, thus making an essential contribution to drug therapy outcomes and quality of life. The number of people affected by diabetes and the costs associated with its management is relatively high worldwide, especially in developing countries like India. Aside from contributing to the financial strain, the problems arising from delays in detection and management are numerous. Clinical pharmacists have been inducted as important healthcare team members in many developing countries medical centers. This article discusses the role of the clinical pharmacist in the treatment of diabetes mellitus, including drug therapy, diabetes care, and education. The main aim of treatment in diabetes treatment has been to optimize drug therapy to achieve improved clinical results without causing drug-related issues. Clinical pharmacists who are well-trained and readily available are key healthcare practitioners who can help patients achieve improved drug treatment outcomes.

 

 

INTRODUCTION:

Diabetes mellitus is a long-term metabolic disorder characterised by hyperglycaemia and improper carbohydrate, lipid, and protein metabolism due to a lack of insulin hormone^{1, 2}. When diabetes is not treated correctly, it can lead to severe hypertension and dyslipidaemia³.

 

Neuropathy, nephropathy, and retinopathy are examples of microvascular illnesses that can be accelerated. Diabetic complications such as coronary artery disease, ischemic stroke, and peripheral vascular disease can be life-threatening if not properly managed⁴.

 

Diabetes can also lead to amputation of the lower limb due to diabetic gangrene, diabetes-related retinopathy, kidney disease, and gingivitis. Diabetes patients are more likely than non-diabetics to die from congestive heart failure and stroke⁵.

 

Glycemic control is critical in the treatment of diabetic patients. More efficient and productive therapies to assist people in adhering to medical regimens are required to reap the benefits of advanced medical treatments⁶.

 

Recently, there was a push to expand the role of community pharmacists beyond the traditional product-oriented duties of selling and delivering medicines to include greater involvement in public health. Due to their in-depth expertise in the ethical use of pharmaceuticals, pharmacists are increasingly being considered to have a significant major role in health care. Pharmacists are becoming a more significant element of the healthcare team, taking on additional duties⁷.

Figure 1: An overview of the evidence-based diabetes management factors

 

Pharmacists are uniquely placed at the interface between patients and their medications to impact medication adherence positively. The World Health Organization (WHO) has reported that pharmacists have an essential role in long-term treatment for chronic conditions, which is far more than just selling medicines⁸.

 

Pharmacists play various positions, including caretakers, communicators, decision-makers, teachers, lifelong learners, leaders, and managers, and they are well-positioned to carry out effective programs. These features allow pharmacists to perform therapies that have been shown to improve drug therapy, save money, eliminate unnecessary side effects, and improve patient clinical outcomes⁹.

 

Local pharmacists are increasingly recognized as being well-equipped and trained to provide chronic disease therapies. One of the few effective methods is community pharmacists’ intervention programs, with benefits ten times greater than costs¹⁰.

 

Pharmacists can play as multidisciplinary teams necessitating that they are adequately trained in various skills, which is not always the case, particularly in third-world countries¹¹.

 

This study observes how pharmacologists in India and other parts of the world assist diabetic patients in enhancing their long-term prognosis by better monitoring and management. We hypothesize that by reducing diabetic complications, pharmacists can help diabetic patients improve their glucose control and standard of living.

 

Search the literature:

The terms pharmacist, diabetes, intervention, randomized controlled trial were used in database searches. PubMed, Medline (Web of Science), Scopus were the databases used. In this study, published were taken to papers written in English articles about diabetes. The quest results are described in the form of narrative analysis ¹².

 

Diabetes mellitus is prevalent throughout the world:

One-third of people with diabetes are admitted to the hospital twice a year, according to the American Diabetic Association. Diabetes management is extremely expensive, with the United States alone spending $92 billion in 2012, and this figure is anticipated to increase by 2020¹³.

 

The disease is a serious metabolic disorder characterized by excessive blood glucose levels, harming the heart, blood vessels, skin, kidneys, and nerves. The most prevalent type of diabetes is type 2 diabetes, which affects more adults and develops when the body gets immune to insulin or does not make enough of it. Over the last three decades, type 2 diabetes has become substantially more widespread in countries of all income levels. Insulin-dependent diabetes, also known as type 1 diabetes, is a chronic illness in which the pancreas produces little or no insulin on its own. Access to cheap diabetic treatment, such as insulin, is critical for patients’ survival. A global agreement to halt the rise in diabetes and obesity has been reached by 2025. Diabetes affects 422 million people globally, most of whom reside in low- and middle-income countries, and is directly responsible for 1.6 million fatalities per year. Both the number of cases and the incidence of diabetes have steadily climbed during the last few decades¹⁴.

 

In 2020, the Indian diabetes market was valued at nearly USD 1,957 million. Between 2021 and 2026, the market is projected to expand by 16.5 per cent, reaching a value of almost USD 4,892.7 million¹⁵.

 

India is among seven nations in the International Diabetes Federation South-East Asia (IDF SEA) regions. Diabetes affects 463 million people worldwide, with 88 million in the Southeast Asian area; by 2045, this number will grow to 153 million¹⁶.

 

It is no exaggeration to say that diabetes is one of the leading causes of illness and premature death worldwide. Diabetes is estimated to be responsible for at least one out of every 20 deaths worldwide and at least one out of every ten deaths in adults aged 35 to 64 ¹⁷. If current trends continue, the incidence of diabetes is expected to more than double by 2030. The majority of this rise will be attributed to a 150 per cent increase in developing countries, where men and women in their economically active years will bear the brunt of the strain. Diabetes is a costly condition due to its long-term complications. Diabetes, for example, is expected to consume between 2.5 and 15% of global healthcare budgets, depending on the prevalence of disease and level of technology available. Person, family, and indirect community costs are more challenging to measure, but they are essential.

 

Clinical pharmacist role in the management of DM:

The word clinical pharmacy was invented to describe the role of pharmacists whose primary responsibilities include interacting with the healthcare team, interviewing and assessing patients, making specific therapeutic decisions, monitoring patient reactions to drug therapy, and disseminating medication information. Clinical pharmacists operate mainly in hospitals and intensive care facilities, and their services focus on the patient rather than the product¹⁸.

 

In certain nations, pharmacy practice has progressed to where clinical pharmacy with patient-centered practice is no longer the exception but the norm for most pharmacists. On the other hand, medical pharmacy is also only practised in inpatient environments and clinics. Patient data and the medical staff are readily accessible: medication instructions, clinical pharmacy progress notices on pharmacokinetic dosing, and other related therapeutic statements¹⁹.

 

Clinical pharmacists with a dynamic and robust experience in disease states and therapeutic understanding of medicines, such as dosing, reactions, indications, side effects, and alternatives depending on the patient condition, play an essential role in pharmacotherapeutic management²⁰.

 

His involvement in substance therapy monitoring has become unavoidable. Clinical pharmacist contributions in recognizing, addressing, and avoiding drug-related issues by supplying interventions are helpful knowledge for clinicians, who can then if they deem it appropriate, enact improvements in drug therapy to improve patient prescription safety, maximize drug therapy, and minimize healthcare costs²¹. Clinical pharmacist strategies have been shown to have a positive effect on patient outcomes, according to researchers. This new paradigm also emphasizes the importance of the clinical pharmacist as a reliable, readily available, and well-trained consulting resource person for providing medication information to physicians and other healthcare professionals to ensure secure, accurate, and cost-effective drug use²².

 

Drug therapy administration: the clinical pharmacist as a resource:

Diabetic management technology has been introduced by hospital-based pharmacists, who have patients upload blood glucose meter readings through the internet every week or have patients download blood glucose meter readings during pharmacist visits. The pharmacist monitors blood glucose levels during doctor visits, provides patient self-management instruction, and develops a customized diabetes management plan to customize medication-therapy regimens for each patient²³.

Clinical dietitians and pharmacists hold two-hour training sessions in grocery stores with pharmacies to educate diabetes patients and consumers on making wise food and medication choices. These workshops include a supermarket tour focusing on reading food labels and making healthy food decisions and seminars on diabetes drugs, drug interactions, drugs that influence blood sugar levels, high- and hypoglycemia symptoms, and glucose control²⁴.

 

Diabetic care and education:

Several controlled trials have repeatedly been published on pharmacist performance in improving glycemic control in various diabetic subpopulations. The majority of the practices recommended that a pharmacist-led diabetes clinic be established to improve treatment involvement, glycemic control, avoid adverse drug events and diabetes complications while improving patient satisfaction and lowering healthcare costs²⁵. The clinical pharmacist most important significant, and visible role in diabetes mellitus is patient education.

 

It should be made available in three phases. The first stage begins as soon as the patient is diagnosed and is designed to help the patient deal with immediate problems and embrace the diagnosis. The second stage offers more detailed information, concentrating on issues found during the patient assessment and any expected needs. The third stage provides ongoing education to patients to reinforce ideas, increase and sustain motivation, and empower self-care management²⁶.

 

Worth of a pharmacist service:

Pharmaceutical treatment increases the efficiency and cost-effectiveness of healthcare services by impacting individual patients’ health. Micro-level improvements affect the overall situation at the macro level²⁷.

 

Pharmacists’ services and participation in patient-centered treatment have been linked to better health and economic outcomes, decreased medicine-related adverse events, increased quality of life, and lower morbidity and mortality. These achievements have been made possible by the incremental expansion of conventional positions and the advent of collaborative substance therapy management programs in some situations. Nonetheless, pharmacists’ ability to make significant changes in public care is largely untapped. Pharmacists offer compassionate care. They must see their work as interconnected and continuous with health services and other healthcare providers. The pharmacists’ job should be built on the relevant, productive, safe, and cost-effective use of resources^{28, 29}. Pharmacists play a part in determining medicine policy at both the local and national levels.

 

Figure 1: Pharmacist responsibilities in patient care

 

Involvement of Pharmacists in Prescription Drugs:

One of the essential professional duties of all pharmacists is to provide drug knowledge. The pharmacist must have outstanding oral and written communication skills to supply drug knowledge effectively. Pharmacists may conduct several drug information tasks, depending on the practice environment and need. Any pharmacist should perform drug information tasks^{30, 31, 32}.

•       Patients and healthcare practitioners are given medication knowledge.

•       We create and update online educational tools for patients and providers on optimal drug use, general health, and specific clinical questions.

•       We are leading in healthcare specialist continuing education programs.

•       Pharmacy students and residents are precepted and trained.

•       We are participating in medication cost assessments and quality management study programs.

 

CONCLUSION:

Diabetes mellitus is a chronic condition requiring a multifaceted approach that includes pharmacological and non-pharmacological interventions to achieve optimal glycemic regulation and clinical results that improve quality of life. The role of a pharmacist in the healthcare team and his involvement in the form of interventions is exceptionally beneficial to physicians during drug therapy, as it improves the quality of treatment while also lowering healthcare costs. Patient education and therapy to improve medication adherence will strengthen the unique pharmacist importance in inpatient care for diabetes mellitus. Even though the number of pharmaceutical products is growing, many parts still lack essential medicines. Healthcare costs and changing social, technological, financial, and political environments have necessitated healthcare reforms. Pharmacists are in a great position to meet the demand for practitioners who can ensure that drugs are used safely and effectively. To do so, pharmacists must take on more responsibility for administering medication treatments for the patients they represent than they currently do. This duty extends far beyond the conventional dispensing practices that have long been the cornerstone of pharmacy practice.

 

ACKNOWLEDGEMENT:

To provide their library support, the authors wish to acknowledge the Ahalia School of Pharmacy, Palakkad, Kerela-678557 and Vinayaka Missions College of Pharmacy, Salem, Tamil Nadu-636008 and other logistic facilities in framing the review article.

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

 

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Accepted on 08.02.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(11):5273-5277.