A pharmacist led diabetes clinic was set up to support a single handed GP practice in which approximately 10% of the practice population had diabetes and 90% of the practice population were from a South Asian background.
The clinics were held once weekly and were bilingual; English, Punjabi or Urdu was spoken at the clinic. Those patients unable to speak either of these three languages, were offered an interpreter. Not only oral diabetes agents were initiated at the clinic, injectable therapy (insulin and Glucagon Like peptide 1 receptor agonist (GLP-1RA)) and even Freestyle Libre 2 was initiated where appropriate.
Although intensive treatment used in the management of diabetes can delay long term complications of type 2 diabetes, in some patients deintensification of diabetes treatment is required for patient safety, to ensure patients are on appropriate medication and to reduce waste and cost of unnecessary treatment.
Deintensification of treatment included:
- deprescribing of antidiabetes drugs such as stopping the drug or reducing the dose
- switching an antidiabetes drug to another with lower risk for hypoglycaemia
- switching to an alternative class which has a better risk-benefit ratio (e.g. SGLT2i's for their cardiovascular and/or renal benefits)
- reducing home blood glucose monitoring
- reducing diabetes-specific assessments such as checking urinary albumin-creatinine ratio
Following deintensification of treatment using a stepwise approach, the patient's HbA1c was measured a few months after deintensification and further treatment adaptation at that time occurred if required. Although the clinic is still ongoing, so far, 23% of patients reviewed by the diabetes specialist pharmacist required deintensification of their antidiabetes treatment.
This innovative project illustrates the appropriate times when deintensification of diabetes treatment should be made.
