Q&A: Pharmacists Play Pivotal Role in Evolving Diabetes Care with New Treatments

The diabetes treatment landscape is poised for significant changes in the coming years, with pharmacists playing an increasingly pivotal role. Dual gastric inhibitory polypeptide (GIP)/glucagon-like peptide (GLP)-1 receptor agonists are showing promising results in lowering blood sugar and aiding weight loss, which could be a game-changer for many patients, according to Megan Smith, PharmD, clinical health coach and Pharmacist at Food City Pharmacy. Additionally, the rise of oral GLP-1 medications may become more popular as patients prefer pills over injections. Beyond GLP-1s, experimental drugs like the tri-agonists and microbiome-based therapies are also being explored. Importantly, GLP-1 medications have shifted the focus of diabetes care from just managing blood sugar to a more holistic approach, addressing weight loss and cardiovascular health. As the market expands, pharmacists will need to focus on personalizing treatments to meet each patient's unique needs, while also educating patients on the appropriate use of these medications and the importance of adherence to prevent serious complications.

Pharmacists educate and counsel patients on effective use of GLP-1 medication. | Image Credit: K KStock | stock.adobe.com

Pharmacy Times®: Going into 2025, what are some drugs for diabetes that pharmacists should keep an eye on?

Megan Smith, PharmD: Yeah, so looking ahead to 2025, there's a few drugs that we should definitely keep an eye on as the treatment landscape for diabetes continues to evolve. A big area is the dual GIP/GLP- receptor, like ttirzepatide (Mounjaro; Eli Lilly). [It's showing] promising results in lowering blood sugar and then also helping with weight loss, which could be a game changer for many patients, especially those struggling with obesity. Another thing to watch is a rise of oral GLP-1 medications like Rybelsus (Novo Nordisk), which is the oral semaglutide, and hopefully more of those coming to market. They, I think, will might become more popular, since some patients will prefer pills over injections. So that's probably some of the things to keep an eye on.

Pharmacy Times: Are there any drugs, beyond GLP-1 medication, that are in the pipeline for diabetes?

Smith: There's a lot happening beyond just the GLP-1. When I was doing some research on this, I found a retatrutide (Eli Lilly). It's an experimental drug of being studied for the treatment of type 2 diabetes and obesity. It's actually referred to as a tri-agonist, and it targets 3 different hormones involved in regulating the blood sugar, insulin secretion, and metabolism. So it works with the GLP-1, the GI P, and then also the glucagon receptors. So it's definitely something that shows some promise in the study so far. Also, [we've] seen some exploration in the microbiome based therapies where scientists are studying the role of gut bacteria and glucose control. The gut bacteria has been shown to play a crucial role in regulation of glucose metabolism and insulin sensitivity. So alterations to the composition and diversity have been observed in diabetic patients with a reduction in the beneficial bacteria. Then I think they'll see an increase in the pathogenic bacteria, which can contribute to progression of the disease, promotes inflammation and impairs the gut barrier functions. So that's something to kind of keep an eye on as well.

Pharmacy Times: How have GLP-1 medications changed the landscape of diabetes care?

Smith: GLP-1 have really shifted how we think about managing diabetes. So traditionally, we focus mostly on controlling blood sugar, but the GLP-1 have added a whole new dimension to it. They don't only just lower the blood glucose effectively, but they're also aiding in weight loss, which is crucial for many patients with type 2 diabetes who are also overweight, which is a really, really high percentage. When I was doing some research, about 80% to 90% of patients with type 2 diabetes are overweight or obese, so that added weight loss benefit is huge. Plus, there's really strong evidence showing that they reduce the risk of cardiovascular events, which is a huge win, considering people with diabetes are at a higher risk of heart disease. Essentially, these medicines have moved just from just managing blood sugar to managing the overall health in a more complete way.

Pharmacy Times: In the GLP-1 space, what can pharmacists expect to see from these medications in 2025?

Smith: We'll likely see a bigger variety of combination therapies involving the GLP-1 medication, which can help patients who need additional control over blood sugar or other health issues. We're also going to see, I think, more options for the oral GLP-1 therapies as the market expands, which will give patients more flexibility and how they want to take their medications. We might actually also see GLP-1s approved for broader uses, such as we've already seen obesity management, [obstructive] sleep apnea, even treatment of the non-alcoholic fatty liver disease. So broader uses for these medications, so the role the pharmacist that is going to continue to grow as more real world evidence becomes available will focus more on personalizing treatments to meet the patient's unique needs.

Pharmacy Times: How can pharmacists best educate patients on the appropriate use of diabetes medication?

Smith: Pharmacists played such an important role in educating patients about their diabetes medications, and it really starts with clear, compassionate communication. It's important to take the time to understand these patients lifestyle, what challenges they may have, and what their preferences are. T hat [can help to] give advice is relevant to them. So for example, when explaining a medication like a GLP-1 agonist, it's helpful not to just talk about how it's going to help lower the blood sugar, but also its weight loss benefits and the potential that it might have to protect their heart. We also need to make sure we're discussing [adverse] effects in a way that empowers the patient and helps to manage them, like addressing potential nausea or the risk of low blood sugar with insulin, and then finally, I think it's really important to help patients improve adherence by offering practical tips like setting reminders, setting up the automatic refills, or help just simplify their regimen when possible. Of course, following up when possible is definitely see whether it's just with a phone call or an in-person visit, or just seeing them in the store and talking to them, just ongoing support can help make a huge difference in how well they'll stick to their treatment plan.

Pharmacy Times: What is the importance of adherence to medication, especially for patients with diabetes?

Smith: Adherence is absolutely critical for patients, not just with diabetes, [but with all disease states], but especially diabetes, and it just comes down to keeping their blood sugar controlled to prevent any serious complications down the road, as patients don't stick to their medication regimens now, their blood sugar can become erratic, which will increase the risk of both short-term problems like severe highs and lows, and also long-term problems like heart disease, kidney failure, and nerve damage. Good aherence often means hopefully fewer hospital visits and just a better overall quality of life. So, as pharmacists, we can play a big role in helping patients stay on track by educating them why their medication is important, help them work through any barriers they might have about taking it like, like the cost, [adverse] effects, or even maybe confusion that they're having about the regimen that they're on.

Pharmacy Times: Is there anything else you would like to add?

Smith: The role of hosting diabetes care continues to grow, and it's more exciting than ever to think about it. With the increasing availability of new treatments and more folks that we have on personalized care, we're in a really unique position to really make a difference in people's lives. So whether it's through educating patients, helping them manage their regimens, or just being a part of this larger health care team, we have the ability to impact the patient outcomes in a meaningful way. So it's really it's a privilege to be in a profession and then have that's an important role in helping patients manage their health.