Greetings to all of my fellow CDE’s! Happy New Year to all. I’d like to take a few minutes in this month’s blog to talk about my area of expertise within the CDE world… diabetes medications. At the risk of sounding … oh let’s say “mature”, the nature, scope and availability of diabetes medications has seen an astonishing growth since I graduated pharmacy school in 1979. As I jokingly like to remark at this point, so many of you were not even born yet.
Treating and educating diabetes patients in the late 70’s was certainly simpler but definitely not better.
The insulin’s available at that time (REGULAR, NPH, LENTE, and ULTRALENTE) all needed to be obtained from animal sources, namely cows and pigs. They worked well enough but were very antigenic in nature, which caused problems. Also because of being from animal sources, there were religious/ethnic considerations.
The only other medication available at that time was oral sulfonylureas which had been developed in the 1950’s. These medications were effective given the options at the time. We still use oral sulfonylureas today but much less often because we have so many other/ better options.
Also at that time, phenformin DBI, a relative of metformin, had recently been taken off the market because of reports of lactic acidosis. metformin would not come along until a few years later.
Contrast that with today:
-11 different classes of medications approved to treat diabetes
-many oral options
-an ever increasing number of new insulins or bio-similar insulins or new insulin concentrations
-injectable medications that are not insulin
-a pipeline of medications for diabetes that includes improvements within current classes as well as new
classes with novel mechanisms.
My struggle as a pharmacist and a diabetes educator is:
-staying on top of the rapid fire introduction of medications for diabetes
-teaching the patients what they need to know, at a level they understand in a period of time that is really not long enough.
I believe all CDE’s struggle with this. I know that all of our patients struggle with this.
In 1991 when I became certified (Thank you Karen Rockwell, RN CDE - it changed my life professionally and personally), very few pharmacists were CDE’s. Today we are an ever increasing group within AADE nationally and locally. I believe that the role of the pharmacist CDE is not just to educate patients but to be a resource to everyone within the diabetes education community as it relates to diabetes medications. Together we can and do empower patients to change lives and save lives.
Thank you
Bob