Prediabetes: Community Interventions

Troy Trygstad, PharmD, MBA, PhD: You’re a small, tight-knit community?

Tripp Logan, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: Almost everybody knows each other. Your kids can probably ride their bikes all around town?

Tripp Logan, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: There is not a whole lot of worry?

Tripp Logan, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: And so, you’ve got a sense of who’s in the community. Would you dare say that there are a lot of folks in your community with prediabetes, or diabetes that has yet be diagnosed?

Tripp Logan, PharmD: Absolutely.

Troy Trygstad, PharmD, MBA, PhD: Have you talked, as a community, about how you might address that?

Tripp Logan, PharmD: Sure. That’s something that’s actually pertinent right now, and we’re looking into ways that we can not only visit with these patients, and screen for prediabetes, but do referrals through our local prescribers to say, 'Hey, these are people who we need to get in the pipeline right now.' One of the challenges, in poor rural areas, is, what’s the expense? What’s it going to cost? And then, from the pharmacist’s perspective, how are we going to get reimbursed for our time, for those assessments, referrals, and so forth? But yes, it’s a big deal.

Troy Trygstad, PharmD, MBA, PhD: What proportion of the time, where you have a chief complaint of ‘X,’ do you end the conversation, with that patient at that visit, with, 'Oh, by the way, you have diabetes. We’re going to start this journey together?'

Javier Morales, MD, FACP, FACE: Well, it actually happens quite often. Part of the beauty of being in internal medicine practice is that you see patients regularly, over years, and years, and years. You start to see some of these changes, that trigger alarms and the need for more aggressive control, especially with prediabetes. It’s actually in epidemic proportions right now, according to the World Health Organization. We’re starting to see more, and more diabetics who are being diagnosed. I believe that there is an increase in public messaging concerning prediabetes, and I think it’s about implementation of appropriate lifestyle intervention. And even if we were to consider pharmacotherapy in the prediabetic patient, there are only certain agents that have been recommended, according to the American Association of Clinical Endocrinologists, for the management of such patients. But there was actually a program, called the Diabetes Prevention Program, which I’m sure that you remember, that favorably concluded that earlier intervention with metformin, in those patients with prediabetes, really did delay the development of diabetes.

Dhiren Patel, PharmD: That’s what actually led to the current legislation, and the ability to get reimbursed by the CMS. Now, the regulation, where it stands, needs to be the live, and not virtual. But, again, this shows that we’re going in the right direction. We have 30 million or so patients who have diabetes. Another 86 million, maybe 3 times as many, are in the pipeline. So, if you think about the burden, and some of these gaps that we’re talking about, that’s just the ones that we have right now. And, 1 and 2 aren’t above an A1C of 8. Think about what’s to come.

Troy Trygstad, PharmD, MBA, PhD: Yes. Different communities have different problems, but almost every community has diabetes. When it comes to diabetes prevention programs, do you know who the number 1 provider of a diabetes prevention program, is in the country?

Dhiren Patel, PharmD: I know the answer to that question. It’s the YMCA.

Troy Trygstad, PharmD, MBA, PhD: There will be a lot of folks, interventionists, out there, who would love to be able to see a more than $2000 reduction—an economic benefit, let alone the health benefit from it. And here, we are talking about the community as being a really important intervention. So, getting out in the community, as practitioners, is clearly important.