A recent Royal Pharmaceutical Society (RPS) policy document stated:
‘Pharmacists can play an increasing role in the prevention, early detection, care and support of people with type 2 diabetes’ (RPS, 2019).
In the policy's foreword, Professor Mahendra G Patel – National Diabetes Campaign Lead and RPS Treasurer – noted that more than 5 million people in the UK will have type 2 diabetes by 2025, with thousands of those people with diabetes experiencing avoidable medication errors. This occurs, explained Professor Patel, against a shifting health landscape in which, for example, the NHS Long Term Plan (NHS, 2019) recognises how clinically skilled pharmacists can support patients and reduce medication errors.
‘The recent establishment of new Primary Care Networks and the growing maturity of local Integrated Care Systems, provide unparalleled opportunities for people to receive better access to their pharmacists, more personalised support, and joined-up care at the right time in the optimal care setting.’
Lisa Miller, Pharmacist Advisor at the National Pharmacy Association (NPA), told the Journal of Prescribing Practice that:
‘The trusted position that pharmacists occupy in the heart of their community means they can play a central role in diabetes management and its complications. The frequency with which diabetics visit pharmacies compared to other healthcare settings makes them good locations for monitoring the patient and any changes in their condition.’
In terms of diabetes treatment, medicines for diabetes cost 11.4% of the total primary care costs and 4.9% of prescriptions items in 2017/2018. There were 53.4 million items prescribed for diabetes in 2017/18, which cost £1 012.4 million; this has approximately doubled since 2007/08 (RPS, 2019).
Interestingly, Professor Patel co-authored a recent paper (Murdoch et al, 2019) demonstrating how a low carbohydrate diet (LCD) can both confer health benefits on type 2 diabetes patients and save money on diabetes-related medicines. Murdoch et al (2019) concluded:
‘The LCD is an increasingly popular option for managing type 2 diabetes that can lead to improvements in the condition, reduced medication burden, and (where needed) weight loss. Primary care clinicians need to be competent in adjusting diabetes medications to achieve safe and effective care.’
It seems that pharmacists' expertise represents a relatively untapped resource. The RPS (2019) pointed out that each year 438 million people in England visit community pharmacies, 81% of which are designated Healthy Living Pharmacies. It suggested that pharmacists are uniquely placed to help implement the NHS Diabetes Prevention Programme, which was launched in England in 2016 to increase capacity and improve access for the programme.
Lisa Miller adds:
‘Pharmacists can improve medicine compliance through schemes such as the New Medicine Service, which aims to educate and support patients in taking their medicines correctly. There is also the opportunity for pharmacists to promote healthy lifestyle changes, which can have a significant impact for patients – especially when it comes to obesity, which is a big risk factor for type 2 diabetes. Prevention and early detection of conditions such as diabetes is a key part of the NHS Long Term Plan, released in 2019, and this is something pharmacists are well placed to support.’
The ability of pharmacists to drive positive health changes is supported by evidence. For example, in a randomised controlled trial of cardiovascular disease risk reduction, undertaken in 56 community pharmacies, Tsuyuki et al (2016: 2852) found that when community pharmacists were involved in identifying individuals at risk of cardiovascular disease and managing their risk factors – including prescribing and ordering laboratory tests – there was a 21% reduction in their cardiovascular disease risk in only 3 months:
‘Because pharmacists are highly accessible primary health care providers, this could have major public health implications in reducing the burden of Cardiovascular disease if these practices were widely adopted.’
This study has particular relevance for pharmacists and diabetes care, given the relationship between cardiovascular disease and diabetes. For example, in an evaluation of 57 peer-reviewed articles that included 4 549 481 individuals with type 2 diabetes, Einarson et al (2018: 1) concluded:
‘Globally, overall Cardiovascular disease affects approximately 32.2% of all persons with Type 2 diabetes. Cardiovascular disease is a major cause of mortality among people with Type 2 diabetes mellitus, accounting for approximately half of all deaths over the study period. Coronary artery disease and stroke were the major contributors.’
It seems that pharmacists can expect to play an increasingly important public health role in the evolution of medical care.