The importance of the pharmacist's expanding role on the diabetes team: reinforcing nutritional guidelines for improved glycemic control.

Abstract

The role of the pharmacist on the diabetes care team is expanding due to the increasing number of patients diagnosed with diabetes, limited health care dollars, and the education related to and required for patients by managed care organizations and insurance companies. In the past, training of patients in diabetes self-management skills has been inadequate, and this continues to be the case. Clinical pharmacists, in cooperation with physicians, have increased opportunities to provide education about medications and may include instructions for patients regarding the interaction of food consumed with changes in blood glucose levels. Because of monthly refills on prescribed medications, a patient's interaction with the pharmacist in the setting of a commercial pharmacy is more frequent than with any other member of the diabetes team. This contact offers an ideal educational opportunity. The action and efficacy of medications that affect the pancreas, hepatic glucose production, the utilization of glucose by muscle cells, and the absorption of glucose from the intestines are influenced directly by the meal plan. Nutritional guidelines, meal planning for the Type I and Type II patient, use of the exchange system, carbohydrate counting, artificial sweeteners, alcoholic beverages, and suggestions for guiding patients to establish eating habits that lead to improved diabetes control are important issues for every member of the diabetes team to address. The reinforcement of dietary principles may occur in the educational setting of the hospital or the clinic or within the commercial pharmacy setting. When the team presents accurate and current information, continuity of care and improved patient understanding are achieved.