Risk Management in Type 2 Diabetes Population

glucometer and medication

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Medication Review to Prevent Drug Therapy Problems

By: Cynthia Nwaubani, PharmD and Tessa Culhane

Type 2 diabetes is the most common type of diabetes in the world. As many as 34 million Americans have diabetes, and 90-95% have type 2 diabetes.1 With the growing number of people being diagnosed with type 2 diabetes, everyday health care professionals devote more time to managing the disease in their patients. 

When cells are not responding to insulin the pancreas makes, the pancreas tries to produce more insulin to trigger a response, but eventually, the pancreas can not keep up with production. The result is hyperglycemia, leading to microvascular effects, such as retinopathy, nephropathy, and neuropathy. It can also lead to macrovascular complications, such as heart failure, stroke, and peripheral vascular disease.2 This can make diabetes management an enormous challenge as it is a chronic condition that will require lifelong treatment. 

Glycemic control is crucial in every patient that is diagnosed with type 2 diabetes. Treatment usually focuses on an oral antidiabetic to help control the patient’s glucose levels. Patients that have type 2 diabetes are usually on multiple medications due to coexisting conditions. These patients are at a higher risk of developing drug therapy problems (DTP) because of their numerous drug regimens. A DTP is defined as an event that interferes with the patient receiving optimal care. Some common DTPs seen in diabetic patients include their dosage being too low, drug therapy ineffective, or the need for additional drug therapy.3 One study conducted in Jordan found that 81.2% of patients recruited with type 2 diabetes had at least one drug therapy problem.4 Another study in Ethiopia found that 58.2% of their study participants diagnosed with type 2 diabetes had at least one DTP.5 These include drug therapy problems, such as drug interactions, polypharmacy, and incorrect drug choice. These problems can cause increased mortality, prolonged hospitalization, and serious adverse events among diabetic patients. 

Another common problem seen among patients with type 2 diabetes is nonadherence to their therapies. Medication adherence in type 2 diabetic patients is essential for maintaining good therapeutic outcomes. Patients require education on the importance of their diabetic medications for their disease. Some common barriers to adherence with diabetic medications are the cost of the medicine and the adverse effects associated with these treatments. Health care professionals should help address any concerns the patient has to help them achieve optimal glycemic control. 

Polypharmacy can also contribute to DTPs in patients that are diagnosed with type 2 diabetes. For example, type 2 diabetes patients have a significantly higher risk of developing cardiovascular (CV) diseases, such as heart failure or stroke, in their lifetime. Many studies have linked poor control of glucose levels to the increase in CV disease.6 Proper control and treatment of type 2 diabetes shows patients can control the progression of many CV diseases. However, multiple medical conditions will result in more medications. Numerous therapies can pose risks for patients, such as falling, decreased quality of life, and adverse drug events/interactions. 

Drug therapy problems can pose significant challenges to healthcare professionals. However, in most cases, these DTPs are preventable. Many studies suggest using a medication review team consisting of pharmacists and physicians reviewing patients’ charts for medication errors. One study found that in reviewing 31 patient charts and dispensing events, they discovered 2,194 medication errors.7 Early identification of DTPs in patients can help prevent any severe adverse events. Pharmacists can help play an essential role on the review team by ensuring that diabetes patients have safe, appropriate, and effective medications. 

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About the authors:

Cynthia Chioma Nwaubani, PharmD, BCGP

Dr. Nwaubani is a board-certified geriatric pharmacist. She is the CEO and founder of PharmD Live. Dr. Nwaubani has a working history delivering high-quality and cost-effective medication management and chronic care services to patients in various healthcare settings.

Tessa Culhane

Tessa Culhane is a PharmD candidate at Lake Erie College of Osteopathic Medicine. Tessa’s main areas of interest include psychiatric medicine and infectious disea

References: 

  1. Type 2 diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type2.html. Published August 10, 2021. Accessed November 4, 2021. 
  2. Long AN, Dagogo-Jack S. Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens (Greenwich). 2011;13(4):244-251. doi:10.1111/j.1751-7176.2011.00434.x
  3. Demoz GT, Berha AB, Alebachew Woldu M, Yifter H, Shibeshi W, Engidawork E. Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. PLoS One. 2019;14(10):e0222985. Published 2019 Oct 1. doi:10.1371/journal.pone.0222985
  4. Al-Taani GM, Al-Azzam SI, Alzoubi KH, et al. Prediction of drug-related problems in diabetic outpatients in a number of hospitals, using a modeling approach. Drug Healthc Patient Saf. 2017;9:65-70. Published 2017 Jul 28. doi:10.2147/DHPS.S125114
  5. Mechessa DF, Kebede B. Drug-Related Problems and Their Predictors Among Patients with Diabetes Attending the Ambulatory Clinic of Gebre Tsadik Shawo General Hospital, Southwest Ethiopia. Diabetes Metab Syndr Obes. 2020;13:3349-3357 https://doi.org/10.2147/DMSO.S267790
  6. Leon BM, Maddox TM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015;6(13):1246-1258. doi:10.4239/wjd.v6.i13.1246
  7. Grasso BC, Genest R, Jordan CW, Bates DW. Use of chart and record reviews to detect medication errors in a state psychiatric hospital. Psychiatr Serv. 2003;54(5):677-681. doi:10.1176/appi.ps.54.5.677

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