US Pharm. 2015;40:1.
November is American Diabetes Month and, as such, is a good time to highlight the sobering statistics of this widespread illness. According to the American Diabetes Association (ADA), the disease affects almost 30 million adults and children in the United States, which equates to about 10% of the population. An additional 86 million people have prediabetes and might develop type 2 diabetes. By some estimates, diabetes will afflict as many as one in three American adults in 35 years.
Other statistics are equally alarming. The ADA estimates that the total cost of diagnosed diabetes in the U.S. is $245 billion, with indirect costs piling on another $69 billion onto that tally from disability, lost work, and early mortality. African Americans and Hispanics have nearly twice the likelihood of developing diabetes as non-Hispanic whites. One in 10 healthcare dollars goes to treat diabetes and its complications, while 1 in 5 healthcare dollars is spent caring for people with the disease.
The ADA says that diabetes nearly doubles the risk for heart attack and for death from heart disease, and is the leading cause of kidney failure. It is also the leading cause of new cases of blindness among working-age adults, and the rate of amputation for patients with diabetes is 10 times higher than for people without diabetes. In addition, some 60% to 70% of people with diabetes have mild to severe nerve damage that could result in pain in the feet or hands, slowed digestion, sexual dysfunction, and other nerve problems.
Diabetes and the Mind
In addition to the myriad of physical problems, diabetes also has psychological components, as detailed in “Coexistent Mental Health Disorders in Diabetic Patients,” by Linsey T. Thomas, PharmD, BCPS, CDE, in this issue. The author points out that diabetes is especially affected by mental health disorders because it is one of the most psychologically and behaviorally demanding of the chronic diseases. As compared to the general population, diabetes is more pervasive in psychiatrically ill patients, the authors note. Depression, anxiety, and schizophrenia are just some of the mental health conditions occurring in patients with diabetes.
This phenomenon undermines healthy outcomes, as patients with both diabetes and psychiatric problems experience worse outcomes. As described by the author, adverse effects on medication adherence, complications risk, functional impairment, and greater medical expenses are seen in this population, even in patients with minor depression. Diabetes and psychiatric illness in tandem correlate to more emergency department, primary care, specialty care, medical inpatient, and mental health costs.
When patients with diabetes become depressed, the author reports, their symptoms persist longer than in patients without the disease—18 months versus 2 to 3 months. Recurrence of depression among patients with diabetes is another deleterious outcome: 92% of patients with diabetes who were treated successfully for major depression relapse at least once in a 5-year time span.
Counseling Paramount
In this special patient population, the role of the pharmacist as counselor is highlighted. Pharmacists can assess individual patients, collaborate in goal setting and skill building, follow up, and provide support. As the author notes, these capabilities fall into the pharmacist’s skill set. Pharmacists, they continue, “…can work with collaborating psychiatrists, primary care physicians, and endocrinologists to enhance patient education, provide more frequent follow-up, monitor adherence to medication, and monitor for side effects and the need for dose titrations. Pharmacists can help patients understand and react to fingerstick readings, a skill that can be used every day.”
Pharmacists can also contribute in more mundane, though vital, ways. For example, they can help make return appointments to primary doctors for patients with persistent symptoms and reinforce the importance of reporting changes in glucose levels. Whatever their degree of involvement, pharmacists should realize the potential coexistence of diabetes and mental health disorders.
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