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Pharmacy Practice and Diabetes Care

      Effective patient-centred care for people living with diabetes requires a collaborative, interdisciplinary team of health-care professionals (
      • Clement M.
      • Harvey B.
      • Rabi D.M.
      • et al.
      Organization of diabetes care.
      ,
      • Tricco A.C.
      • Ivers N.M.
      • Grimshaw J.M.
      • et al.
      Effectiveness of quality improvement strategies on the management of diabetes: A systematic review and meta-analysis.
      ). Ideally, each member of this team provides unique and complementary expertise to help patients develop and follow a comprehensive care plan, make healthy behaviour and lifestyle choices and, ultimately, improve health outcomes (
      • American Diabetes Association
      3. Foundations of Care and Comprehensive Medical Evaluation.
      ,
      • Community Preventive Services Task Force
      Diabetes management: Team-based care for patients with type 2 diabetes.
      ). Because most people living with diabetes will require drug therapy (
      • McGibbon A.
      • Richardson C.
      • Hernandez C.
      • Dornan J.
      Pharmacotherapy in type 1 diabetes.
      ,
      • Leiter L.A.
      • Berard L.
      • Bowering C.K.
      • et al.
      Type 2 diabetes mellitus management in Canada: Is it improving?.
      ), it is very likely that a diabetes care team will include a pharmacist. Pharmacists contribute to the diabetes care team by using their medication knowledge, skills and professional judgement to ensure each patient's medication needs are managed.
      Pharmacists work in a variety of settings across Canada, and they have seen substantive changes in the scope of pharmacy practice over the past decade. These factors can lead to variations in the perception of pharmacy practice, especially as it relates to diabetes care. This issue of Canadian Journal of Diabetes brings together a collection of articles that explore facets of pharmacy practice in Canada as they relate to diabetes care.
      Almost 75% of Canadian pharmacists work in community pharmacies, which are highly accessible and often serve as an initial point of contact with the health-care system for patients (
      • Canadian Institute for Health Information
      Pharmacists in Canada.
      ,
      • Canadian Pharmacists Association
      ). Within this setting, community pharmacists are well positioned to educate patients and health-care professional colleagues about the safety, effectiveness and potential interactions of prescription medications, over-the-counter (OTC) medications and natural health products. This role is important because many people living with diabetes use OTC medications and natural health products (
      • Ryan E.A.
      • Pick M.E.
      • Marceau C.
      Use of alternative medicines in diabetes mellitus.
      ,
      • Fabian E.
      • Toscher S.
      • Elmadfa I.
      • Pieber T.R.
      Use of complementary and alternative medicine supplements in patients with diabetes mellitus.
      ). In this issue, 2 review articles examine the implications of OTC medications and natural health products for diabetes care. Taylor (
      • Taylor J.
      Over-the-counter medicines and diabetes care.
      ) reviews OTC medications that are commonly used for management of minor ailments, such as cough and cold products and nonsteroidal anti-inflammatory drugs, and how these can affect diabetes management. Necyk and Zubach-Cassano (
      • Necyk C.
      • Zubach-Cassano L.
      Natural health products and diabetes: A practical review.
      ) review the current evidence and summarize the safety and effectiveness of the 10 most commonly used natural health products with antidiabetic properties. Collectively, these articles provide insight into some of the factors that pharmacists consider when discussing the use of nonprescription and alternative therapies with patients and health-care professionals.
      Over the past decade, provinces across Canada have introduced legislation that allows pharmacists to expand the range of services they provide to patients. Within this expanding scope of practice, pharmacists in many provinces are able to initiate and adapt drug therapy, administer medications by injection and order laboratory tests. Although the scope of practice varies across provinces (
      • Canadian Pharmacists Association
      ), pharmacists can have a substantial, positive effect on the care of people living with diabetes, especially when they work collaboratively with their health-care professional colleagues. In this issue, Mansell and colleagues (
      • Mansell K.
      • Edmunds K.
      • Guirguis L.
      Pharmacist's scope of practice: Supports for Canadians with diabetes.
      ) report on an environmental scan they conducted to summarize the regulatory changes affecting pharmacy practice across Canada and describe how these changes can affect diabetes care. In addition, 2 Perspectives in Practice articles help put some of these legislative changes into context. First, Gagnon and colleagues (
      • Gagnon A.
      • Jin M.
      • Malak M.
      • et al.
      Pharmacists managing people with diabetes in primary care: 10 years of experience at the Hamilton Family Health Team.
      ) describe their experiences as pharmacists providing pharmacy services within family health teams for the past 10 years. Second, Al Hamarneh and colleagues (
      • Al Hamarneh Y.
      • Siemens R.
      • Townsend K.
      Top 10 things pharmacists should consider when they interact with patients with type 2 diabetes.
      ) discuss the “Top 10” things that pharmacists should consider when they see someone with type 2 diabetes.
      Although legislative changes enable the evolution of practice, it is important to measure the effect of practice change on patient care. Two Original Research articles in this issue examine the evidence to support pharmacist involvement in diabetes care. In the first article, Al Hamarneh and colleagues (
      • Al Hamarneh Y.N.
      • Hemmelgarn B.R.
      • Hassan I.
      The effectiveness of pharmacist interventions on cardiovascular risk in adult patients with type 2 diabetes: The Multicentre Randomized Controlled RxEACH Trial.
      ) explore the effect of community pharmacy-based interventions on cardiovascular disease risk in people with diabetes. In the main randomized controlled trial, pharmacists used their full scope of practice, including ordering laboratory tests and initiating drug therapy when necessary, to help patients meet guideline-based treatment targets (
      • Tsuyuki R.T.
      • Al Hamarneh Y.N.
      • Jones C.A.
      • Hemmelgarn B.R.
      The effectiveness of pharmacist interventions on cardiovascular risk: The Multicenter Randomized Controlled RxEACH Trial.
      ). The substudy reported in this issue explores how the intervention achieved its success. In the second article, Yaghoubi and colleagues (
      • Yaghoubi M.
      • Mansell K.
      • Vatanparast H.
      • et al.
      Effects of pharmacy-based interventions on the control and management of diabetes in adults: A systematic review and meta-analysis.
      ) report the results of their systematic review and meta-analysis examining the effects of pharmacy-based interventions on outcomes associated with diabetes-related complications. This study adds to the growing body of literature examining the effects of pharmacy-based interventions in diabetes by summarizing the observed changes in glycated hemoglobin levels and body mass index, as well as health-care utilization and quality of life.
      Finally, we know that health-care professionals benefit from an active support system that enables them to deliver care. Indeed, the long-term care model, which has been in use for many years, acknowledges that interventions aimed at training and supporting health-care professionals can lead to better patient outcomes (
      • Wagner E.H.
      • Austin B.T.
      • Von Korff M.
      Organizing care for patients with chronic illness.
      ,
      • Grol R.
      • Grimshaw J.
      From best evidence to best practice: Effective implementation of change in patients' care.
      ). In this issue, MacCallum and Lewis (
      • MacCallum L.
      • Lewis G.
      Creation of a diabetes pharmacists network in Canada.
      ) describe the steps taken to establish a nationwide network of pharmacists with a shared interest in diabetes care. The network enables pharmacists to connect with and learn from each other with an ultimate goal of increasing active participation of pharmacists in diabetes care. In addition, Verweel and colleagues (
      • Verweel L.
      • Gionfriddo M.
      • MacCallum L.
      • et al.
      Community pharmacists' perspectives of a decision aid for managing type 2 diabetes in Ontario.
      ) examine pharmacists' opinions of decision aids and their place in community pharmacies. This study focused on the Diabetes Medication Choice, which is a decision aid aimed at helping patients make informed decisions about diabetes medications (
      • Breslin M.
      • Mullan R.J.
      • Montori V.M.
      The design of a decision aid about diabetes medications for use during the consultation with patients with type 2 diabetes.
      ).
      There is strong evidence that team-based care is an effective strategy for diabetes care (
      • Tricco A.C.
      • Ivers N.M.
      • Grimshaw J.M.
      • et al.
      Effectiveness of quality improvement strategies on the management of diabetes: A systematic review and meta-analysis.
      ,
      • Community Preventive Services Task Force
      Diabetes management: Team-based care for patients with type 2 diabetes.
      ). We hope the collection of articles in this issue of Canadian Journal of Diabetes inspires you to encourage more active pharmacist involvement within your diabetes care team.

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