‘Pharmacists Are the Care Coordinator’ in Type 1 Diabetes, Expert Says

In a Pharmacy Times^® interview, Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice, clinical pharmacist, Massachusetts College of Pharmacy and Health Sciences, highlights the different roles pharmacists have in various settings as well as teplizumab (Tzield; Sanofi) in type 1 diabetes treatment. Pharmacists are significant care coordinators, and help connect patients with the correct resources, communicate and work with other members of the care team, and help remove barriers so patients can receive continuous care.

Pharmacy Times: What role do inpatient pharmacists play in supporting teplizumab therapy?

Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP: In the inpatient setting, pharmacists ensure proper baseline labs are completed before initiating teplizumab, such as CBC, LFTs, viral status, Epstein-Barr virus, and so forth. And we also manage drug–drug interactions, verify vaccines are up to date, educate care teams on premedications to prevent infusion-related reactions. If a patient is transitioning from inpatient to an outpatient infusion center, we help coordinate continuity of care so we can avoid delays in any treatment.

Pharmacy Times: How do infusion center pharmacists contribute during the 14-day teplizumab regimen?

Goldman: Infusion pharmacists prepare weight-based doses each day and ensure proper dilution administration protocols and make sure those are followed, monitoring for cytokine release syndrome, infusion reactions, and help nurses manage premedications, like acetaminophen or antihistamines. We are involved in patient education, emphasizing why completing all 14 doses is critical for long-term benefit.

Pharmacy Times: What unique challenges and opportunities exist in managing pediatric patients eligible for teplizumab?

Goldman: Pediatric patients and their families often need more support and education, and pharmacists explain the importance of early intervention what it means to be in stage two and why delaying stage three could spare them years of insulin use and reduce complications like [diabetic ketoacidosis]. In the infusion setting, we make sure that the experience is age appropriate, safe, reassuring, addressing parental anxiety [as well as] ensuring families are educated on disease course, therapy expectations, and postinfusion monitoring is important. Pediatric pharmacists can also work with schools and families to ensure the child's care plan is supported outside of the clinic. They have to do that 14-day infusion.

Pharmacy Times: How do pharmacists work with the broader care team to support teplizumab initiation and access

Goldman: Pharmacists are care coordinators. We connect patients with [teplizumab] compass navigators to help with insurance approvals in a copay program, logistics, and patient education. You can find that online. Just search that terminology, "Tzield compass navigators." We also liaise with prescribers, nursing teams, infusion centers, and specialty pharmacies to ensure smooth ordering, educating the broad care team on administration protocols, monitoring for adverse events, managing transitions between care settings. Our goal is to remove barriers and keep the patient supported from the first conversation to postinfusion monitoring.