Pharmacy Times interviewed American Diabetes Association Scientific Sessions speaker Ivan de Araujo, MSc, DPhil, associate professor of psychiatry at Yale University School of Medicine, on the pharmacist’s role in helping patients manage their diabetes and remain adherent to treatments. de Araujo also discusses his hopes for future research in diabetes research, including drugs that target a specific area without circulating to other areas of the body.
Key Takeaways
- Individualized Treatment Management in Diabetes Care: Pharmacists play a critical role in diabetes care by tailoring treatment plans to individual patients' needs, particularly in managing responses to medications—such as GLP-1 agonists—which can vary widely in their efficacy and adverse events (AEs).
- Interdisciplinary Collaboration in Diabetes Management: The development and application of diabetes drugs involve a multidisciplinary approach, from molecular biology and neuroscience to patient care. Pharmacists are essential in this process, particularly in managing drug-drug interactions and ensuring the safe and effective use of new treatments.
- Proactive Adverse Event Management: Pharmacists are essential in educating patients about potential AEs and managing these to ensure adherence to treatment plans, ultimately helping to mitigate negative reactions and improve long-term health outcomes.
Pharmacy Times: What unique role might the pharmacist play in diabetes care (eg, education, treatment management)?
Ivan de Araujo: Yeah, this is a good question because—I mean, of course, education is a big factor there—I think pharmacists can be very important when we think of individual variations in terms of responses to treatment. So, when you look at—for example, [GLP-1 agonists] that are in the market now and are very successful and used by a large number of diabetic patients—the data, you're going to see that there is a considerable variation in terms of how people respond to the drug, and there's people going from not responding all the way, to feeling very nauseous and sick for the same dose in a way that is not obviously related to the [patient's] body weight. So, I think pharmacists can have a very critical insight into trying to understand the individual needs and the sensitivities and matching them to the appropriate dose response.
Pharmacy Times: Can you provide examples of interdisciplinary approaches to diabetes management that involve pharmacists?
de Araujo: Yeah, I think the development of new drugs is 1 clear example because if you look at how these drugs are hypothesized, discovered, and applied, it goes all the way from molecular biology, cloning the genes that produce certain gut factors, then there is the determination of the structure and identity of the receptors, then you involve neuroscientists that try to understand in which areas of the brain these drugs may act—for example—to inhibit appetite or change insulin release, and this goes all the way into the patient end where the appropriate doses and responses and types drug-drug interactions, which is another critical part that pharmacists may relate to: how different drugs may interact in a particular patient.
So, I would say yeah...drugs currently being used for treating diabetes and curbing appetite is a good example of a multidisciplinary type of work where the factors were discovered when research was being done on a different topic, they realize they have an effect in controlling blood sugar and appetite. And this comes all the way into the application to patients where the role of pharmacists [is] certainly critical.
Pharmacy Times: How can pharmacists help patients when adhering to their treatments? Are there any proactive measures pharmacists can take to help?
de Araujo: From my point of view—[as one who] works with research and reactions to these medications—I think the 1 big issue is [adverse events (AEs)] that are more likely to be present in some individuals than others, and there is no good understanding of why certain individuals respond negatively and eventually give up treatment and others do not. There is no obvious "generic" or other type of explanation, so I think the management of [AEs] and the education about what they may represent and how likely it is that they will persist, this is something that is [a] very important type of information for patients to adhere to the treatment. And certainly, [pharmacists are] the ideal person to educate and guide the patients because that's basically what they have been trained for, to understand the interactions between these chemicals and the physiology of the human body.
Pharmacy Times: Are there new treatment protocols on the horizon that show promise in diabetes care, and what would you like to see in this space?
de Araujo: Yeah, I think there is now a tendency to look for novel drugs that are long-lasting [and] require fewer doses to produce the same effect, and this has been going very well.
I think that 1 thing that I would like to see in the future are drugs that produce similar effects, but do not necessarily go all over the body, because then, that's probably where the AEs [can] come from...you're activating receptors in targets that are not relevant for your application. So, I think a very interesting development—and very powerful—would be the development of new drugs that act only on gut tissue and particular receptors, and from there, the information is transmitted from the periphery to the brain without the drug itself going into circulation to target certain areas of the brain that cause AEs—for example—gastroparesis, nausea, or vomiting, or problems with the gallbladder...
So, if we could in the future develop new drugs that are more specifically targeting gut tissue that can be used in lower doses, I think we could simultaneously benefit from appetite reduction and glucose control [while] avoid[ing] some of the [AEs] that lead patients to eventually stop the treatment.
