role of pharmacist in diabetes management

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    1. Role of Pharmacist Management and Novel

    Therapies of Diabetic Nephropathic Patients

    K.P. Sampath Kumar*, DebjitBhowmik, Lokesh Deb, ShravanPaswan,2012

    It has been predicted that worldwide the prevalence of diabetes in adults would increase to

    5.4% by the year 2025 from the prevalence rate of 4.0% in 1995. Consequently the number of

    adults with diabetes in the world would rise from 135 million in 1995 to 300 million in the year

    2025. It is expected that much of this increase in prevalence rate will occur in developing

    countries. While a 42% increase is expected in developed countries, a 170% increase is expected

    in the developing countries

    Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys

    caused by diabetes. In severe cases it can lead to kidney failure. But noteveryone with diabetes

    has kidney damage .The kidneys have many tiny blood vessels that filter waste from yourblood.

    High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able

    to do its jobas well. Later it may stop working completely. This is called kidney failure. Certain

    things make you more likely toget diabetic nephropathy.

    Diabetes can affect many parts of the body, including the kidneys. In healthy kidneys, many tiny

    blood vessels filter waste products from your body. The blood vessels have holes that are big

    enough to allow tiny waste products to pass through into theurine but are still small enough to

    keep useful products (such as protein and red blood cells) in

    the blood. High levels of sugar in the blood candamage these vessels if diabetes is not

    controlled.This can cause kidney disease, which is alsocalled nephropathy (say: nef-rah-puh-

    thee). If thedamage is bad enough, your kidneys could stopworking.

    There are no symptoms in the early stages. So its important to have regular urine tests to find

    kidney damage early. Sometimes early kidney damage can be reversed. The first sign of kidney

    damage is a small amountof protein in the urine, which is found by a simple urine test. As

    damage to the kidneys gets worse, your bloodpressure rises. Your cholesterol and triglyceride

    levels rise too. As your kidneys are less able to do their job, youmay notice swelling in your

    body, at first in your feet and legs. Community pharmacist can take to increase theirinvolvement

    and contribution to public health at a local level in collaboration with other public health. During

    thisrole shift, the competency of community pharmacists is in higher demand than ever before. In

    view of availability ofnumerous new medicines and drug delivery systems, community

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    pharmacists are challenged to ensure that patientsget maximum benefit from their medicines. It is

    essential that discovery of new drug, new therapeutics effect ofelatively older drugs, clinical

    trials, toxicological studies etc. are all carried out involving community pharmacy at

    different phases.

    Diabetic nephropathy has been categorized into stages: microalbuminuria and macroalbuminuria.

    If abnormal, it should beconfirmed in two out three samples collected in a

    three to six-months interval. Additionally, it isrecommended that glomerular filtration rate be

    routinely estimated for appropriate screening ofnephropathy, because some patients present

    adecreased glomerular filtration rate when urinealbumin values are in the normal range.

    The twomain risk factors for diabetic nephropathy arehyperglycemia and arterial hypertension,

    but thegenetic susceptibility in both type 1 and type 2diabetes is of great importance. Other risk

    factorsare smoking, dyslipidemia, proteinuria,glomerular hyperfiltration and dietary factors

    In patients with type 2 diabetes, renal lesions are heterogeneous andmore complex than in

    individuals with type 1diabetes. Treatment of diabetic nephropathy isbased on a multiple risk

    factor approach, and the goal is retarding the development or progressionof the disease and to

    decrease the subject'sincreased risk of cardiovascular disease

    Signs and Symptoms of DiabeticNephropathyDiabetes can affect many parts of the body,including the kidneys. In healthy kidneys, manytiny blood vessels filter waste products from yourbody. The blood vessels have holes thatare bigenough to allow tiny waste products to passthrough into the urine but are still smallenoughto keep useful products (such as protein and redblood cells) in the blood. High levelsof sugar inthe blood can damage these vessels if diabetes isnot controlled. This can cause kidney disease,which is also called nephropathy (say: nef-rahpuh-thee). If the damage is bad enough, yourkidneys could stop working. Early signsandsymptoms of kidney disease in patients withdiabetes are typically unusual. However, avastarray of signs and symptoms listed below maymanifest when kidney disease hasprogressed

    Albumin or protein in the urine

    High blood pressure

    Ankle and leg swelling, leg crampsGoing to the bathroom more often at night

    High levels of blood urea nitrogen (BUN)

    and serum creatinine

    Less need for insulin or antidiabetic

    medications

    Morning sickness, nausea, and vomiting

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    Weakness, paleness, and anemiaItching

    2

    Lifestyles which have been established for many years are not easy to change

    and health care professionals cannot expect immediate adherence to the plan

    of management. Assess the SNAP risk factors (Smoking, Nutrition, Alcohol and Physical

    activity) and establish a long term lifestyle plan.

    It is important for the patient to have all the information available so thata common sense of purpose between the health care professionals and the patient can

    develop. This takes time and some patients may decide to reject advice.

    Professionals need to maintain an open approach and emphasise that help

    is available when required.

    Weight reduction is often difficult. A combined program of healthy eating, physical

    activity and education directed at behavioural changes is often successful. Carer and

    peer encouragement helps these behavioural changes.

    Health care professionals need to be sensitive to patient views concerning

    diabetes and be ready to counsel. The normal stresses of daily living can

    affect diabetes control. Seek opportunities to help patients regain control,

    to improve self esteem and to understand and control their condition.

    There is a range of approved educational materials produced by State and TerritoryDiabetes Organisations which can be recommended to the newly diagnosed person

    with diabetes.

    Education is ongoing and needs to continue for the rest of the persons life. Diabetes

    knowledge, especially self care skills (blood glucose monitoring, foot care, insulin

    administration) need to be assessed regularly (eg: as part of the complication screen

    at the twelve monthly review).

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    3.Diabetes education and knowledge in patients with type 2 diabetes from the communityThe Fremantle Diabetes Study

    David G. Brucea,*, Wendy A. Davisa,b, Carole A. Cullc, Timothy M.E. Davisa, 2003

    Provide education

    1. Diabetic patients obtain knowledge of the condition from a variety of sources. These

    include education programs and

    encounters with health-care staff such as during instruction on self-monitoring of blood glucose

    (SMBG).

    Diabetes education programs,

    diabetes-related visits to dieticians and SMBG are associated with, and may be important sources

    of, improved diabetes knowledge in

    patients with type 2 diabetes.

    2. Problems: Our data provide evidence that barriers to access or utilization ofcontemporary diabetes education confront

    older patients, minority groups and those with language difficulties

    3. Adequate knowledge of diabetes is a key component of

    diabetes care (Beaser, Richardson, & Hollerworth, 1994).

    The potential benefits of diabetes knowledge include a sense

    of empowerment and improved quality of life (Beaser et al.,

    1994; Brown, 1990; Padgett, Mumford, Hynes, & Carter,

    1988). While it has been difficult to demonstrate that formal

    diabetes education per se leads to improved metabolic

    control (Lockington, Meadows, & Wise, 1984), it is clear that improvements in outcomes cannot

    occur without

    adequate instruction about diabetes (Beaser et al., 1994).

    To this end, all people with diabetes are encouraged by the

    American Diabetes Association to attend formal diabetes

    education programs (Department of Health and Human

    Services, 1991).

    4. Information about diabetes is obtained from a variety of

    sources including one-to-one interactions with doctors,

    nurses and dieticians. Self-monitoring of blood glucose

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    (SMBG) requires considerable instruction and could be an

    important additional source of diabetes knowledge for many

    patients. The value of SMBG in patients with type 2 DMwho

    are not on insulin treatment has been questioned because of

    doubts about beneficial effects on glycemic control (Evans

    et al., 1999; Faas, Schellevis, & Van Eijk, 1997; Kennedy, 2001)

    5. instruction was associated with the highest knowledge

    scores. Where patients had been exposed to only two of

    these activities, diabetes education provided a more important

    contribution to knowledge than SMBG or dietetic advice

    6. Alternatively, those who attend programs

    already have the qualities of adherence that are helpful in

    improving their self-management behaviors. Many studies

    have found little or no relationship between knowledge and

    behavior (Beaser et al., 1994; Lockington et al., 1984),

    while it has been repeatedly demonstrated that diabetes

    education programs lead to gains in diabetes knowledge

    (Brown, 1990; Karlander & Kindstedt, 1983; Padgett et al.,1988) as reflected by the present data.

    Diabetes

    7. The experience of living with insulin-dependent diabetes:lessons for the diabetes

    educator

    Hernandez, C.A., 1995

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    8. The Scope of Practice of Diabetes Educators in a Metropolitan Area

    Mariorie Cypress, Judith Wylie-Rosett, Samuel S. Engel and Terry B. Stager,1992

    Other health care professionals as diabetes educator.

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    The responses of the registered nurse and registered dietitian respondents, contribute to

    the most as diabetic education.more than 75% of the nurses performed 5 of the educator

    roles

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