Source: University of auckland (UoA)
Diabetes patients in South Auckland had remarkable success in a trial of using community pharmacists as coaches.
A pilot programme in South Auckland has shown that community pharmacists, working closely with general practice nurses, can significantly reduce blood sugar levels for people with diabetes – and keep them down.
Type 2 diabetes is a major health challenge in Aotearoa New Zealand, leading to preventable complications such as dialysis, amputations, vision loss, and heart disease.
The programme, run by Counties Manukau Health and funded by the Ministry of Health, enrolled a total of around 60 people, with a new paper focusing on 26 participants who enrolled early and had long-term follow-up data. See Journal of Primary Healthcare.
Participating pharmacist, Carole Baxter, at Unichem Tuakau Pharmacy recalls one patient whom she and the nurse referred to as ‘the poster boy’.
“We told him what he would need to do – lifestyle changes, moving more, improving his eating and taking his medications. Whatever we said, he did. He ended up not needing to take any medications.”
Baxter believes the pilot would have been even more successful if it hadn’t coincided with the start of the Covid-19 pandemic.
“It shows that diabetes patients really need a coach,” Baxter says. “It was often simple things like finding people weren’t testing regularly because they had left their meter at a tāngi or moved house and couldn’t find it. Issues that were easily resolved.”
Baxter wrote long-term-condition plans for the patients and is still following up with activities like checking they have an appointment to get their next script. “A few days later, the script turns up in the pharmacy,” she says.
At the outset of the trial, patients’ average HbA1c was 97.6 mmol/mol.
HbA1c, a long-term measure of blood sugar control, should ideally be under 53 mmol/mol – a target many people do not meet.
During the pilot, patients had an average reduction of 25.2 mmol/mol, or 20.7 mmol/mol for Māori and Pacific participants.
When the patients were followed up after seven months, the participants had sustained their improvements
Most, participants (85 percent) improved their HBA1C by at least 5 mmol/mol.
“Rates of prescribing of newer diabetes medicines such as empagliflozin and dulaglutide, were higher than comparable studies in people with type 2 diabetes in New Zealand eligible for these treatments,” says lead author Dr Natalie Gauld, an honorary senior lecturer in the School of Pharmacy at Waipapa Taumata Rau, University of Auckland.
“We’d love to see a larger trial with more pharmacies and a comparison group,” says Gauld.
“Having a pharmacist mentor would help build confidence and support pharmacists in this new way of working. It’s also vital to involve Māori and Pacific communities in designing the next phase.”
Dr Sue Tutty, GP liaison at Counties Manukau and co-author, says the programme highlights the value of collaboration.
“It showed how relatively small interventions, utilising a team-based model of care, can have a significant impact on outcomes.”
Researchers recommend scaling up the approach with more emphasis on team-based care and better integration between pharmacies and general practices, mentoring for pharmacists, and additional support for patients who feel overwhelmed or disconnected from the health system.
“This project is scalable now with the resources we currently have in the community, and with motivation and project support,” Tutty says.
