The Pharmaceutical Journal Vol 266 No 7152 p805-704
June 16, 2001

What pharmacists can do for diabetes

This week is National Diabetes week. Clare Bellingham investigates the potential for pharmacists to become involved in screening for diabetes

One million people in the United Kingdom have undiagnosed diabetes, according to the charity Diabetes UK. It is using National Diabetes week, just coming to an end, to highlight the condition with an awareness campaign, “too many too late”. Diabetes UK says that many people are being diagnosed with diabetes so late that they have already developed complications of the condition. The charity says that potential exists for pharmacists to become involved in both early detection of diabetes, and health promotion and education about the condition.

Along with the one million people with undiagnosed diabetes, there are 1.4 million people in the UK with diagnosed diabetes. The incidence of diabetes is increasing, with the number of people with diagnosed diabetes set to double by 2010, probably a result of a growing incidence of obesity and sedentary lifestyles.

Diabetes and its complications account for 9 per cent of total NHS expenditure: £5.2bn in 2001. Early diagnosis could prevent some of the complications of diabetes and consequently reduce costs to the NHS thus saving money spent on screening services, providing such services are appropriately targeted at high-risk groups.

However, Diabetes UK says that 68 per cent of health districts do not recommend any type of early identification programme and that 50 per cent of GP practices do not have any policy on screening for people with diabetes. The charity’s report “too many too late” recommends that health services should focus on early identification of people with diabetes.

Pharmacist screening

The large number of people with type 2 diabetes who are not accessing current screening services provides a potential role for involvement of community pharmacists, according to Diabetes UK. Certainly, community pharmacists have access to people who are apparently healthy and who rarely come into contact with GPs or nurses. While pharmacists can offer a screening service, diagnosis of diabetes should be conducted by GPs.

In May, the Society’s Practice Committee considered a draft guidance document on the community pharmacist’s role in early identification of diabetes (PJ, June 9, p778). It is being developed in anticipation of opportunities for pharmacists that could be created in the National Service Framework for Diabetes due to be published later this year. The NSF aims to set national minimum standards of diabetes care covering prevention, identification and management of diabetes and its complications, including rehabilitation and continuing care.

On May 25, Diabetes UK published a position statement on early identification of people with diabetes. “There should be an active programme in place for identifying people with diabetes across the UK, one that particularly focuses on those at increased risk of developing type 2 diabetes,” it says.

Diabetes UK does not recommend general population screening but instead target screening to high risk groups which include those aged over 40 years, a family history of diabetes, African-Caribbean or Asian origin, obesity, hypertension, hyperlipidaemia, a history of myocardial infarction or cerebrovascular disease, gestational diabetes and polycystic ovary syndrome.

Although it says that screening is probably most cost-effective when performed as part of a general health review in primary care, it adds that “other venues such as pharmacies may be appropriate provided staff are adequately trained in the actual measurement techniques and in the advice and support to be given to those with abnormal results and suitable quality control mechanisms are in place”. Clear referral guidelines are also essential if screening is performed outside primary care, it says.

Diabetes UK recommends that screening should take place every three years. Screening for diabetes can be performed using a suitable quality controlled laboratory or a standardised near-patient method. However, diagnosis of diabetes must be based on an accredited laboratory method, it says.

In order to offer diabetes screening services, pharmacists will need additional training on the testing procedures and how to give appropriate counselling on the results, diabetes itself and lifestyle advice.

Irene Gummerson, member of the Society’s diabetes task force, says: “It is important for pharmacists to liaise with local health care diabetes professionals to get their opinions on board.” In terms of which screening tests should be used, she says that the fasting blood test is the most accurate but possibly the least popular with patients. In certain instances, when it is better to test than not to test at all, a random blood test or urine test two hours after a meal can be used. Random urine tests are the least accurate.

Some pharmacies already offer diabetes screening. Lloydspharmacy is evaluating a screening service, featured this week in the BBC’s Healthwatch programme.

And in the future, pharmacists could offer additional near-patient tests, in combination with blood glucose testing, for example overnight fasting blood cholesterol profiles.

Education is another area in which pharmacists can become involved. “People with diabetes must be made aware of the implications of having diabetes and the need to take control of their condition. To achieve this we need proper education and support programmes run by healthcare professionals who know about diabetes,” Diabetes UK says. It recommends covering aspects such as what diabetes is, how to manage the condition, what the complications of diabetes are and how they can be prevented and how diabetes can impact on life, eg, driving regulations for people on insulin.

Non-invasive blood glucose test

And with the potential market for diagnosing and treating diabetes so huge, companies are eager to have a slice of the cake. For example, a machine that uses a non-invasive method of blood glucose sampling was launched this week. The GlucoWatch Biographer uses a process called reverse iontophoresis which uses a low current to pull glucose through the skin. The machine provides glucose readings every 20 minutes giving an accurate picture of glucose levels over a 12-hour period that is stored for three months. An alarm sounds if readings are too high, too low or rapidly declining and an arrow indicates a trend in readings. The GlucoWatch is available directly to patients or via diabetes clinics and costs £250. Further information can be found at www.glucowatch.com.

Symptoms of undiagnosed diabetes

• Increased thirst
• Increased frequency of urination, especially at night, and cystitis
• Extreme tiredness
• Weight loss
• Genital itching or regular episodes of thrush
• Blurred vision

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Clare Bellingham is on the staff of The Pharmaceutical Journal