Drug Therapy Management and Diabetes

Drug therapy management has traditionally been concerned with ensuring correct dosage, avoiding drug interactions, and educating patients about possible side effects. People identified as being at high risk for medication-related problems include those with chronic and multiple diseases, those who take multiple (five or more) medications, and those who see multiple health care providers. Because people with diabetes often fall into these categories, drug therapy management is especially important. It includes comprehensive reviews of medication and medical records, education of patients to improve compliance with medication regimens, and an assessment of individual response to therapy to ensure timely interventions and coordination and continuity of care.

Drug-related Problems

Today’s pharmaceuticals and advanced medical technologies provide many therapeutic options for treating diabetes and its comorbidities. If used inappropriately, however, they can cause serious illness, long-term disability, or even death. A study released in February 2001 shows that misuse of prescription drugs in the United States costs $177 billion annually in additional treatments, hospital care, and doctor visits, up from $76.5 billion in 1995. More important than the costs, however, the study estimates that 218,000 prescription drug-related deaths annually are due to misused prescription medications (62). The study identifies several categories of drug-related problems, including improper drug choice, underdosage, overdosage, adverse drug reactions, drug interactions, and undertreatment. Additional identified factors include untreated medical conditions and medication use with no indication (63, 64). More than 50% of those with chronic disorders do not take their medication properly. Over 60% of persons with diabetes do not adequately control their blood glucose. Of persons treated for high blood pressure and high cholesterol, 65% and 49%, respectively, are unable to reach target blood pressure and total cholesterol levels (65). To improve compliance and minimize these health care adversities, medication therapy regimens must be consistently and carefully monitored. Correct use of medication improves health and saves money for the health care system (66–68).

Strategies for Managing Drug Therapy

People with diabetes should establish a relationship with a pharmacist who can help monitor drug regimens, advise how to take medications properly, and provide other information to help them control their diabetes. Strategies include the following:

• Use of medications. Individualize drug regimens to determine the best time to take medications to reduce side effects and drug interactions. Offer behavior strategies, compliance aids, appropriate dosage forms, and a drug delivery system.

• Self-treatment and over-the-counter medications. Ask patients with diabetes if they are using nonprescription medications; vitamin, herbal, or nutritional supplements; or topical and skin-care products. Assess the severity and urgency of the person’s complaint, the appropriateness for self-treatment, and any precautions and contraindications. Recommend self-treatment, follow-up, and/or referral to another health care professional, as appropriate.

One study reported that over 57% of people with diabetes use complemetary and alternative therapies (69).

• Selecting and using a blood glucose meter. Help the patient choose an appropriate blood glucose meter and provide training on how to use it. Educate the person about the results, actions to take, and when to seek help. Self-monitoring blood glucose (SMBG) is an important way to assess the effectiveness of therapy.

• Cost control. Advise on ways to decrease costs of medications and supplies by providing information on private insurance plans, prescription drug programs, Medicare and Medicaid, the role of generic medications, and possible coverage for referrals to other health care providers.

May 2007

National Diabetes Education Program (NDEP)    http://ndep.nih.gov
NIDDK, National Institutes of Health, Bethesda, MD

A Joint Initiative of the National Institutes of Health and the
Centers for Disease Control and Prevention