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Preventing the Progression of Pre-Diabetes

Diabetes affects 20.8 million people in America, and 6.2 million of those affected are unaware. Even more startling is the number of people with pre-diabetes—54 million people have blood glucose levels in this range, and these patients are the ones who are not frequently recognized as needing medical attention or lifestyle changes. The inconsistency in which these patients are coached provides an excellent opportunity for pharmacists, such as Jennifer Musick, to offer innovative services to their patients.
Pre-diabetes is defined by the American Diabetes Association as a fasting blood glucose between 100 and 125, or a random blood glucose level between 140 and 199. It is a condition that occurs when blood sugars are not normal, but are not high enough to be considered diabetes.
Who is at risk for elevated blood glucose levels? People who are above age 45 and have a BMI greater than 25 should receive regular screenings. Patients under the age of 45 should be screened if they have high blood pressure, low HDL levels, high triglycerides, a family history of diabetes, have had a history of gestational diabetes, or if they belong to a high risk ethnic group. Patients diagnosed with pre-diabetes should be assessed every 1-2 years for type 2 diabetes.
What is a prevention program? Prevention programs for diabetes teach people to be successful in averting diabetes. Through blood glucose screenings and education offered at screening, patients can learn about options for managing their blood sugar.  Several diabetes prevention studies have shown that patients with pre-diabetes can prevent progression without drugs, simply by making modest lifestyle changes. Lifestyle intervention proved to be more effective than both the placebo groups and the patients using metformin.
Why are prevention programs so important? Blood glucose screenings are crucial because they increase awareness and can help prevent diabetes, also decreasing the likelihood of heart disease and stroke. Many physicians don’t recognize pre-diabetic levels as a problem, and only address elevated blood sugar in the diabetic range. Patients who discover they have elevated glucose levels in the pre-diabetic stage can stop the progression into diabetes by making simple lifestyle changes. Early detection makes the changes more subtle and easier to incorporate into a patient’s current lifestyle. Most cases caught in the preliminary stages can return to normal levels within a year!
What is the pharmacists’ role in these programs?  Pharmacists can have a huge impact in preventing the progression of their pre-diabetic patients. Other health care professionals do not manage pre- diabetes—physicians are not usually concerned with pre-diabetic levels—so this is an opportunity for pharmacists to assume a leadership role and get involved where no one else has. Pharmacists often have more direct and frequent access to patients than other providers and can easily provide information and coaching regarding lifestyle changes.
What is necessary to start a prevention program? Establishing a diabetes prevention program is simple! Few tools are required to launch—a regular blood sugar meter can be used to test patients’ levels, and informative pamphlets for patients are also essential but easily obtained. Pharmacy staff and students can help with patient education and with teaching patients about the risks associated with diabetes. A partnership with pharmaceutical or diagnostic companies and/or local employers can help to fund screening programs.
What should be done with the results of screenings? All patients should be educated on the risks that accompany diabetes. Patients who have experienced blood glucose levels in the pre-diabetic range should be encouraged to make a few lifestyle changes in order to prevent progression into the diabetic range. These modifications include walking five times per week, implementing appropriate nutritional changes, and food tracking. Patients at high risk should discuss increased activity plans with their physician prior to implementation. Education should be provided about food groups and portion control. Critical results, such as a patient in the diabetic range who was previously unaware, should be faxed to the patient’s physician.
Prevention programs offer pharmacists an important opportunity to provide excellent patient care in a problem area that is frequently unaddressed by other health care providers. Screenings detect pre-diabetic patients early and allow prevention into diabetes with lifestyle modifications. These programs are simple to implement and can have a significant impact on patient health.