Diabetes is a prevalent and rapidly growing condition. According to charity Diabetes UK, someone will be newly diagnosed around every three minutes by 2025. In 2013, this condition affected 3.2 million and will increase to an estimated 5 million within a decade.
And the NHS must be braced for a bigger financial hit – Diabetes UK has warned the condition cost £10 billion every year, a figure that is set to rise to more than £16bn over the same period.
But Amy Rylance, head of healthcare professional engagement for the charity, stresses: “While it’s easy to see diabetes as an impending disaster, there is still hope.”
This hope lies in the NHS’s Diabetes Prevention Programme – a joint commitment from NHS England, Public Health England and Diabetes UK to deliver, at scale, an evidence-based behavioural programme to support people to reduce their risk of developing type 2 diabetes.
“This is an exciting development because it means that for the first time, people are taking seriously the idea of preventing diabetes at a national level. There is clear evidence that diabetes prevention can work,” says Ms Rylance.
By helping people to understand and manage their condition, health professionals can also prevent associated complications, such as damage to blood vessels, nerves and organs.
Pharmacy has an important role to play in dealing with this fast-growing problem, says Robbie Turner, chief executive officer of Community Pharmacy West Yorkshire. Working within the heart of communities, “pharmacy teams can take national information about diabetes, such as that provided by Public Health England, and give advice relevant to people’s lifestyles”, he says.
Community pharmacists can investigate how well the condition is being managed. Sometimes, people’s diabetes may not be controlled – there can be a long delay between diagnosis and acting upon it. Elizabeth Hackett, principal pharmacist for diabetes at University Hospitals of Leicester NHS Trust, says: “Pharmacists have an opportunity to intervene, such as asking questions to find out how well a patient’s blood sugars are being managed, and signposting them to other health professionals to better control their diabetes.”
One of the reasons patients’ diabetes may not be controlled is because they are not taking their medication, or not taking it in the way prescribed. “We know that a lot of people with type 2 diabetes don’t take their medications, so compliance is an issue. But it can be something community pharmacists can enquire about,” says Ms Hackett.
Non-compliance with diabetes medication could be because the patient is concerned about side effects, or does not have time to see their doctor to discuss their difficulties. Mr Turner points out that pharmacists are experts in being able to build up a rapport with patients, “and so are ideally placed to have conversations about diabetes medications to build solutions”.
A sensitive approach is essential when discussing someone’s compliance with their medication and pharmacists also emphasise that these patients should be treated as individuals. One tactic is to find out what resonates with them, says Ms Hackett. “If I have a patient I suspect has a compliance issue, I may ask if they have accidentally forgotten to take their medicine. It’s important to ask gentle questions because you don’t want people to feel defensive.”
Ms Rylance advises that MURs offer another opportunity to review scripts and help people look at how they can get the most benefit from their medication.
The role of hospital pharmacy
Hospital colleagues also have a vital part to play in helping to support diabetics, and the challenges they face can have a knock-on impact on community pharmacists. In 2013, the National Diabetes Inpatient audit found that 37% of inpatient drug charts had at least one medication error from the previous seven days. “There are a huge number of drugs prescribed for diabetes with similar names, so it can be confusing for medical staff, particularly junior staff, when making prescribing decisions,” says Ms Rylance.
Hospital pharmacy can therefore help to reduce the rate of these errors. “We know that in some hospitals, pharmacy has played a key role in building understanding among hospital staff about different diabetes drugs and ways that errors can be combated,” says Ms Rylance.
Preventing the onset of diabetes
To help address the rising numbers of people with diabetes, it is crucial that health professionals focus on prevention as well as treatment, which involves encouraging people to lead a healthy lifestyle. “It’s all about education,” says Ms Hackett. “Pharmacists can help people to understand the value of healthy eating, to maintain a healthy weight and to take regular exercise. They are in a great position to do this based on previous relationships they already have with customers, and knowing relatives of family members that have diabetes or a genetic predisposition to it,” she says.
Schemes such as the Healthy Living Pharmacy (HLP) initiative are building skills and competencies for staff to offer advice about preventing long-term conditions, including diabetes. Mr Turner cites examples of pharmacists who have helped people to live well, such as organising local walks for their communities or running Fruity Fridays – where pieces of fruit are given free to customers to highlight the importance of a good diet.
One pharmacy’s healthy lifestyle initiative even bagged a C+D Award. Inspired by a weight-loss event held at a local Gaelic club, Bannside Pharmacy in Northern Ireland created Portglenone Gets Healthy!, a scheme to encourage weight loss. The idea was simple: eat well, exercise often and come to the pharmacy for initial measurements and weekly weigh-ins. It was so successful that it earned the pharmacy the C+D Award for Public Health Initiative of the Year 2015.
Bannside Pharmacy’s superintendent pharmacist, Eoghan O’Brien, was involved in running the scheme from September to December 2014. During that time, 100 people enrolled to take part in activities and workshops, which included stress management, dietary advice and exercise, such as spin classes at a local gym. The results speak for themselves – 28 of the participants had lower diabetes risk assessment scores after taking part.
This initiative highlights just how far pharm-acists can go to reduce the risk of diabetes in their communities. “We can do so much. And we constantly reinforce what patients can do to help themselves,” says Mr O’Brien.
While medication “is great to help stop people getting into serious problems”, pharmacists should also empower people to take more responsibility for their own health, including people with diabetes, he advises.
To help people with long-term conditions, Mr O’Brien focuses on four key areas: nutrition, exercise, stress management and social inclusion (encouraging people who may be feeling isolated to engage with others, such as through team sports).The benefits of being active “have been shown time and again”, he says, and it is important to encourage people to find an activity they enjoy doing.
Mr O’Brien believes nutrition is an essential part of diabetes prevention, but he stresses that it is important to take an individual approach when dealing with patients’ diets because “what can be healthy for the majority of the population can cause havoc for the blood sugar levels of some individuals”.
Stress management is also a critical part of managing long-term conditions such as diabetes, because helping people to manage emotions also has a knock-on effect on their physical wellbeing, Mr O’Brien has found. Encouraging individuals to improve their social life benefits them both emotionally and physically, he says.
Identifying undiagnosed diabetics
As well as patients who are aware they are living with the condition, Diabetes UK estimates there are about 500,000 people who are still undiagnosed. Pharmacists can use their knowledge about this condition to identify these patients and ensure they receive prompt advice and support.
But how do you begin this conversation? Mr Turner says the NHS Health Check programme offers “an ideal opportunity for pharmacists to identify if a person is at higher risk of type 2 diabetes”. He believes that if a pharmacist knows a patient well, this will also encourage discussions about changes in their health, which could result in identifying the signs of diabetes and prompt a GP referral.
Another potential tool in pharmacists’ arsenal is a diabetes risk assessment. Diabetes UK has a risk tool available online and some pharmacy organisations offer this simple self-assessment in their stores.
Two years ago, Boots UK launched its own diabetes risk assessment in partnership with Diabetes UK to provide personalised advice on how people can take control of their health and manage their type 2 diabetes. The free programme offers day-to-day access to expert advice on the high street around all aspects of diabetes management – from reducing a person’s chances of developing the condition to helping people with the condition understand their medication and look after their eye health.
The early identification of type 2 diabetes means better support and treatment. “This will reduce the likelihood of serious complications later, which not only has benefits for patients but also significantly reduces the financial burden of diabetes on the NHS in the future,” says Mr Turner.
As well as keeping an eye out for at-risk patients, an initiative set up by Diabetes UK in 2014 is helping pharmacists take a proactive role by becoming a ‘diabetes champion’. Ms Hackett was the first pharmacist to join the clinical champion programme, which aims to improve the consistency of care for diabetic patients.
Ms Hackett explains that she began specialising in diabetes care 13 years ago. “I particularly enjoyed working with a very supportive diabetes team who really appreciated what I did for them in my capacity as a pharmacist. My passion grew from there,” she says.
Her role as clinical champion is to explore and establish ways to deliver better care to diabetic patients. Being selected as a clinical champion “was a great honour”, she says. “I am very proud to be the only pharmacist of 29 champions. I am hoping to be able to help and encourage pharmacists to be more involved in diabetes care. I think pharmacists can play a major role and we need to explore ways to become more involved and supportive of medical and nursing colleagues who already care for [these] patients,” she says.
Diabetes UK is now encouraging other pharmacists to become champions as well. “The point of the scheme is to identify and support those exceptional clinicians who can improve local services. We were thrilled to get Elizabeth’s application,” says Ms Rylance.
“In February we are recruiting for the next cohort of clinical champions and are interested in applications from pharmacists,” she adds. If pharmacists really want to tackle the rise of diabetes, now is their chance.