Patient Safety: Diabetes Dialogue Can Prevent Error, Save Money

With FDA approval of more than 20 new therapies for diabetes since 2010, clinicians and patients are often overwhelmed with treatment choices.

Pharmacy teams—pharmacists and pharmacy technicians—can help clinicians and patients navigate the maze of available treatments successfully and prevent misadventure. That's the message in a new article that discusses a range of topics including proper injection techniques, red flags that prompt calls to the prescriber or consultation with the patient, and common safety issues.

This peer-reviewed article, published by the University of Connecticut School of Pharmacy, is a primer in ensuring patient safety for the more than 30 million Americans who have diabetes. Since more than 90% of diabetes care is delivered in ambulatory care settings, patient safety is a critical issue for pharmacists and technicians who practice in the community.

In the article, the author discusses how the treatment landscape has changed recently and gives a brief review of clinical treatment guidelines, including important points like the circumstances under which HbA1c may be inaccurate.

The author also provides concise information about anti-hyperglycemic therapies that are proven to reduce cardiovascular events and mortality, and reviews administration techniques for the growing number of injectable drugs. About one third of patients who have diabetes are insulin users, and need appropriate counseling. Of note, approximately 20% of insulin users administer the wrong dose, increasing the risk of severe hypoglycemia. According to the authors, patients switching between products may be unaware of subtle differences, leading to improper technique and loss of glycemic control. Pharmacists and pharmacy technicians should identify patients starting on new insulin products or changing doses and provide counseling.

In terms of safety, the author discusses hypoglycemia and counseling patients about how to treat it, concurrent use of antidiabetic agents, and common drug interactions. Pharmacists should be aware of drugs that increase hypoglycemia risk, are prescribed for comorbid conditions that may lead to hyperglycemia or worsen renal function, and are likely to decrease the patient’s ability to recognize hypoglycemia. Counseling patients on how to identify and treat low blood sugar symptoms can help ensure patient safety.

According to the author, insurance formulary changes and preferences are of concern to patients with diabetes and national diabetes associations, and may increase costs. The author noted that being aware of substle differences can that can cause astronomical price changes can help pharmacists and pharmacy technicians ensure patients use the most cost-effective option.

Additionally, it reminds pharmacists and pharmacy technicians that albiglutide will be unavailable after July 28, and that they should forewarn patients who currently use albiglutide and discuss transition to new medication regimens with their prescribers.

Reference

Hutchinson K. Diabetes Dialogue for Patient Safety: Talking with Patients and Prescribers. February 15, 2018. Available at https://ce.pharmacy.uconn.edu/wp-content/uploads/sites/2102/2018/02/Patient-Safety-Diabetes-FEB2018-FINAL.pdf. Accessed February 22, 2018.