Quick Diabetes Screening Guide to Assist Pharmacists in MTM

Diabetes is a serious condition that is characterized by high blood sugar, excessive urination, increased appetite, and extreme thirst. When an individual has diabetes it is important that several other therapies are implemented to keep other factors under control such as blood pressure, cholesterol, and others.

As a pharmacist it is our job to ensure that our patients with diabetes are receiving the therapies they need and we should also be able to identify those patients based off of their medication profiles. Below is a quick screening guide that can be used to not only identify patients with diabetes but to also help get them the treatments that they need including a brief summary of non-pharmacologic interventions.

Anti-Platelet Therapy:

· Aspirin (75-162 mg/day) should be initiated as primary prevention against CVD in patients with Type 1 and Type 2 diabetes.

· If the patient has an aspirin allergy, clopidogrel 75mg/day should be initiated as an alternative.

Blood Pressure Medications:

· Medication to control blood pressure should be initiated in patients with diabetes that have blood pressure values greater than 140/90.

· First-line treatment: ACE-Inhibitors (ex: Lisinopril) or ARBs (ex: Valsartan)

· The majority of diabetes patients will require additional therapy such as Thiazides (ex: HCTZ) or CCB (ex: Amlopidine)

Cholesterol Control:

· Individuals 40-75 years of age with diabetes with LDL-C 70-189 mg/dL should be started on statin therapy.

· Depending on their ASCVD risk an individual may be placed on either a moderate or high intensity statin.

Vaccinations:

· Hepatitis B: Unvaccinated adults 19-59 years old

· Influenza: annually for patients greater than or equal to 6 months

· Pneumococcal: Age 2-64 years: PPSV23, Age greater than or equal to 65: Prevnar 13 and one year later PPSV23

· Tetanus: Every 10 years

Non-pharmacologic therapy:

· Yearly urine tests to measure urine albumin excretion

o Urinary albumin excretion greater than or equal to 30 à Start an ACEI or ARB

· Yearly eye exam to detect signs of retinopathy

o If eye exam is normal and blood glucose is stable, screening can be every two years

· Yearly foot examination

o Patients should also self-monitor for dryness, cracking, and ulcers daily

o Patients should refrain from walking barefoot

· Low fat high fiber diet (whole grains, vegetables, legumes), Mediterranean diets fatty fish (EPA, DHA), Sodium intake <2300mg/day, reduce saturated fat intake to 5-6% per ADA, reduce trans-fat and increase fiber intake.

· Regular exercises Moderate-intensity (30 minutes per day at least 5 days a week)

· Smoking cessation

· Weight loss for overweight and obese patients

· Maintain waist circumference of <35 inches (females) and <40 inches (males)

Reference

American Diabetes Association (ADA) Position Statement. Standards of Medical Care in Diabetes — 2016. Diabetes Care. 2016;39 (suppl 1):S1-S112.