As a healthcare professional like a pharmacist we can deliver a very good quality of healthcare services to the common people. Here I have spoke to you about the possibilities of a pharmacist in controlling a chronic disease like diabetes mellitus. I have clearly mentioned the process of controlling such disease through simple slides. I hope all of you will get some help from it. Thank you.

1. ROLE OF PHARMACIST IN THE MANAGEMENT
OF DIABETES
SOMNATH DAS
B.PHARM 3RD YEAR, 6TH SEM
ROLL NO- 18901916041
DR.B.C. ROY COLLEGE OF PHARMACY AND A.H.S.
DURGAPUR - 713212

2. CONTENTS
 INTRODUCTION
 SERVICES BY PHARMACIST – GENERAL OUTLOOK
 DETAILED INSIGHTS OF THE PROCESS IN THE CARE OF T2DM PATIENTS
 FUTURE ROLE OF PHARMACISTS IN CONTROLLING T2DM
 CONCLUSION
 REFERRENCES

3.  Diabetes mellitus is the term which has gained a wider currency and has been becoming a burden into
the medical science hold a grave threat in India and other countries also.
 As a consequence managing of such a chronic disease, health care intervention become important for
taking care of the treatment of diabetic patients properly.
 Medication non-adherence is the main common issue in the management because of its complex and
lifelong therapy. As the patients do interacts with pharmacists on a regular basis they have a key role in
making those patients get adhere to medication through time to time instructing and reminding them.
 In fact Pharmacist has the appropriate knowledge to monitor the patients profile with diabetes
mellitus and thereby can decrease the overuse of medication therapy or also can suggest new types of
available methods for controlling the situation. Pharmacist plays a key role in the use of injectable
therapies, including incretin based treatment with glucagon like peptide 1 receptor agonists.
 They can also educate patient regarding different injection techniques, medication storage etc.
 Thus here I will express the emerging role of a clinical pharmacist in light of the present scenario.
INTRODUCTION

4. PHARMACIST’S BASED SERVICE ON T2DM
PATIENT’S
T2DM Patients
INITIAL ASSESSMENT
•Medical History
•Physical Examination
•Laboratory Evaluation
TREATMENT PLAN
•Individualized treatment targets
•Individualized treatment plan
-Diet, exercise, anti-diabetic agents
-Prevention of complications
•Patient’s education
TREATMENT
ASMINISTRATION
•Medications prepared
•Instructions for use are provided
•Patient education
MONITORING
•Monitor compliance to
treatment plan
•Monitor treatment
outcome
•Adverse treatment effect
REVIEW
•Review of treatment
plan
•Consider:
-Adjust treatment
plan
-Adjust education
-Referral

5. PROCESS INVOLVED IN THE CARE OF
PATIENTS WITH T2DM
STAGE Initial assessment
ACTIVITY History taking
COMPONENTS
•Specific symptoms of Glycosuria/Hyperglycemic
•Age, family history, obesity, lifestyle issues (smoking, alcohol, physical activity, diet,
occupation)
•RISK FACTORS FOR COMPLICATIONS: personal or family history of cardiovascular disease,
overweight, hypertension, dyslipidemia
•SYMPTOMS OF COMPLICATIONS: cardiovascular symptoms, neurological symptoms, renal
problems, foot & eye problems
•Medications (if any)
•Psychosocial status, e.g., attitudes about illness, resources- financial, social & emotional,
expectations

6. Contd.
STAGE Initial assessment
ACTIVITY Physical examinations
COMPONENTS
• Cardiovascular systems, e.g., blood pressure measurement
• Eyes, e.g., pupil dilation
• Weight/Waist: BMI, waist circumference
• Peripheral nerves, e.g., sensations
Laboratory examinations
COMPONENTS
• Glycemia: HbA1c
• Lipids: LDL-C, HDL-C, total cholesterol, triglycerides
• Renal functions: plasma creatine (eGFR), albuminuria

7. Contd.
STAGE Treatment Plan
ACTIVITY Individualized Treatment Plan
COMPONENTS
• Glycemic control: HbA1c
• Control of risk factors for complications:
lipids, blood pressure, cigarette consumptions, BMI
• Urinary albumin excretion
ACTIVITY Development of Treatment Plan
COMPONENTS
•Anti-diabetic medications
•Diet
•Physical activity
•Prevention or treatment of complications

8. Contd.
STAGE Treatment Plan
ACTIVITY Patients Education
COMPONENTS
•Diabetes disease process
•Treatment targets
•Treatment plans
• anti-diabetic medication: dosing instructions, use of insulin injections,
storage requirements, special precautions, important adverse effects
•Exercise
•Diet
•Prevention/treatment of complications: foot care, smoking cessations,
medication for high lipid/blood pressure levels
•Monitoring:
•SMBG(using glucose meter & interpreting the results)
•Need for regular medical monitoring

9. Contd.
STAGE Treatment Administration
ACTIVITY Medications prepared &
Appropriate instructions provided
COMPONENTS
•Dispensed in accordance with legal requirements
•Prescription labels on direction for use
•Ancillary labels(if any)

10. Contd.
STAGE Monitoring
ACTIVITY Monitor compliance to treatment plans
COMPONENTS
•Medications
•Exercise plans
•Diet plan
•Prevention/treatment plan for chronic complications
•Scheduled medical monitoring
ACTIVITY Monitor treatments outcomes
COMPONENTS
•Glycemic control
•Risk factors control
•Presence of complications

11. Contd.
STAGE Review
ACTIVITY Monitoring adverse effects &
Review of treatment plan based on monitoring results
COMPONENTS
•Presence of adverse drug effects
•Consider treatment adjustment
•Consider education adjustment
•Referral

12. Effectiveness of pharmacy-based interventions in supporting
People with T2DM
Studies that were conducted in India
R. Adepu et al.,2007 ,Performed a study of six months in two community pharmacies in
Calicut, Kerala, India. A total of seventy (48 male and 22 female) type 2 diabetes mellitus
patients were enrolled. , pharmacist provided patient counseling has an impact in improving
the perception about disease, diet and life style changes and in turn on glycemic control and
overall quality of life in diabetic patients.
Venkatesan R et al.,2012 Fifty patients were interviewed, of whom 39 subjects were
included in the study. Intervention group showed better progress in the recovery of diabetics
because of the continuous counselling and monitoring.

13. FUTURE ROLE OF PHARMACISTS IN
CONTROLLING T2DM
 PROS:
 Till date evidence shows that the association of pharmacists in controlling the disease state proved to be very
effective. In fact the best possible outcome of the disease control comes by the intervention of pharmacists.
 Delivery services within other settings like hospitals, clinics and community based clinics is likely to be better
received by patients with pharmacists being seen more as care provider than a supplier of medicines.
 CONS:
 Diabetes screening is another area of significant need which pharmacists need to engage in as many people
living with disease remain undiagnosed. It should not be underestimated because it is seen that consumer do not
perceive community pharmacies as a place to go to get assistance with their diabetes care. Consumers have
consistent concerns about the knowledge and competency of a pharmacists to provide additional service.
 However large scale future implementation depends on the government aids, mass education and supports. For
example, depending on the level of remuneration one would envisage that a limited number of community
pharmacies specializing in diabetes would offer extended service.

14. Conclusions
 There is a significant evidence to support the role of a pharmacist in providing a range of extended diabetes care
services, from screening to ongoing disease state management. However, despite this, the provision of such
services generally remains limited and inconsistent. However this is set to change as the number of people with
T2DM grows and the capacity of traditional care providers to cope with this people diminishes. Pharmacists are
ideally placed to assist patients with their diabetes management within a range of clinical settings as
demonstrated by current evidence. Needed now are model of practice which are evidence based, consistent, and
scalable such that they deliver the outcome desired by all stakeholders.

15. References
 International Diabetes Federation
 Jeffery David Hughes, Yosi Wibowo, Bruce Sunderland, Kreshnik Hoti: the role of pharmacists in the
management of T2DM: current insights and future directions; Integrated Pharmacy Research and Practice
2017:6 15–27

16. THANK YOU