Helping Patients Manage Diabetes Burnout

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When my daughter was diagnosed with type 1 diabetes (T1D) about 18 months ago, I couldn’t even express how devastated I felt. I’ve been a pharmacist for about 20 years and even with my background it was overwhelming. Diabetes management is constant work. Whether the patient has T1D or T2D, the condition can be very stressful. While joining various support groups online, I noticed a lot of discussion about diabetes-related burnout.

The CDC recognizes that diabetes-related burnout is real,1 noting that “over time, the emotional burden of managing diabetes can cause burnout.” Drug topics® asked several experts about how pharmacists can help patients or caregivers who suffer from burnout due to diabetes.

Amanda Lane, MS, RD, LDN, CDCES, is the founder of Healthful Lane Nutrition, LLC. “Diabetes distress or exhaustion can be different for everyone,” she said. “Some patients may be angry with their medications or check [blood glucose]; others may brush it off with vague terms like “everything is fine,” avoiding appointments, and not refilling medications on time. »

Stephanie Redmond, PharmD, CDCES, BC-ADM, Co-Founder and Vice President of Diabetes Doctor is a clinical pharmacist and diabetes educator. When determining if a patient is suffering from diabetes burnout, she looks for the following signs:

• Patient does not refill prescriptions on time, indicating that he is not taking medication.

• The patient does not bring their meter, indicating that they are not monitoring their blood glucose as instructed.

• The patient has not followed for a long time or does not want to talk about his diabetes.

According to Lane, patients who need more medication or higher doses feel like they are doing something wrong. In these cases, “helping the patient or a caregiver learn how to fill a pill organizer can be an extremely helpful way to address diabetes-related distress,” she explained. “Seeing all the pill bottles multiple times a day can be overwhelming, but having a box with the right medications can be less overwhelming.”

For some patients, Lane recommends continuous glucose monitoring (CGM). However, she noted that there should first be a conversation about comfort level with new technology. “Some patients are more stressed with managing the increased technology required by CGM, while others find the reduction in finger pricks and increased glucose readings incredibly helpful,” she added. .

“Pharmacists are more involved than ever in the distribution and education of CGM,” added Redmond. “Wearing a CGM can have a huge real-time impact and teach lessons that blood sugar testing never can. [Patients can] immediately see the benefits of taking medicine, going for a walk, or eating nuts instead of chips for a snack.

Lane noted that Medicare covers CGM in patients who meet specific criteria. People with T1D or T2D with multiple daily injections or other qualifying criteria can usually get CGM through their insurance. However, insurance may dictate which brand of CGM is covered.

Redmond suggested that pharmacists use motivational interviewing techniques, such as asking open-ended questions and giving the patient time to respond. “I love repeating what they’ve said to me, to give them a chance to react positively… [for example], “You feel like nothing you do is helping your blood sugar.” This gives the patient a chance to respond, “Well, when I walk on Saturday, I noticed that Sunday was my best day,” she explained.

Redmond also encouraged pharmacists to focus on the patient’s good blood sugar days, rather than bad ones, and brainstorm together what makes a difference. “It helps encourage self-reflection,” she said.

Pharmacists can also give hope and encouragement to patients. “They’re not alone,” Redmond said. “It helps to find a supportive community, even online, of other people with diabetes who have ideas or diet/exercise/lifestyle advice that has worked for them.” Pharmacists can remind patients to seek help, but not medical advice, from their peers.

Pharmacists should also help patients with a plan of action when checking blood sugar. “If you check the blood [glucose] but to do nothing with this information, it seems really useless to verify,” noted Redmond. Pharmacists can make sure the patient has a plan on how to deal with the ups and downs, along with a prescription for glucagon and most importantly, knows how to use it and can train loved ones or caregivers on how to use it. administer in case of hypoglycemic emergency.

Redmond tells his patients, “Focus on making your next decision a good one. Even if you’ve been eating chocolate chip cookies all day and feel like the day is wasted, you don’t have to commit to going to the gym next week or eating no carbs. Just make your next decision, whether it’s dinner or a bedtime snack, a healthier decision. Or maybe you have to walk 10 minutes after dinner. One decision at a time seems easier than trying to undo a whole year of bad habits. Small changes have a big impact in the end.

Redmond also reminds pharmacists to advise patients on their medications. “Often patients take different medications for their diabetes and don’t understand why they would take more than one. But if they understand that they work in different ways or have different benefits, they are more likely to take them” , she says.

It also offers information on adverse effects (AEs) and solutions, so that patients know that certain AEs do not mean failure. “For example, metformin tells your liver to stop producing as much [glucose] because you don’t need it. If you notice loose stools, let me know; we can switch to a long-acting tablet which can help or reduce your dose. Your other medicine, dapagliflozin [Farxiga]helps your kidneys urinate more [glucose] which the body does not need. This means you also lose calories, which can help you lose weight. Most individuals notice an increase in urinary frequency for the first week or so, but this improves over time.

“When [a treatment plan] logic, patients want to take it and want to be healthier,” Redmond said.

Reference

1. Dealing with diabetes-related burnout. CDC. Updated January 26, 2022. Accessed June 20, 2022. https://www.cdc.gov/diabetes/library/spotlights/diabetes-burnout.html


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