A pharmacist and health promoter team to improve medication adherence among Latinos with diabetes.

BACKGROUND: There is a need to improve blood glucose levels of underserved Latino patients with uncontrolled diabetes. OBJECTIVE: To determine the feasibility of a pharmacist and health promoter team designed to address the barriers to medication adherence and adjustment and improve self-care among Latinos with type 2 diabetes. METHODS: Clinical staff at the University of Illinois at Chicago Medical Center referred Latino patients with uncontrolled diabetes (hemoglobin A(1c) [A1C] > or =8.0%) to the study. A research assistant assessed patients on diabetes and medical history, medication list, medication adherence and related habits, health literacy, diabetes knowledge and numeracy, beliefs in benefits of diabetes therapy, depression, social support, and access to care. A bilingual, bicultural health promoter reviewed these assessments and worked with patients through home and clinic visits and telephone calls. The health promoter communicated with a pharmacist to receive assistance in medication management (reconciliation and adjustment). Participants received case management for 6 months. RESULTS: Nine patients were successfully recruited. The mean age was 58 years and mean duration of diabetes was 21 years. Successful collaboration between pharmacists and the health promoter required frequent communication and intense effort to address complex patient barriers. Health promoter contact time, in person, per participant ranged from 0 minutes to 640 minutes, and telephone call time ranged from 27 minutes to 111 minutes during the study period. Eight participants had medication adjustments during the study period, with a maximum of 7 adjustments per participant. Mean hemoglobin A1C declined from an average of 9.6% to 9.0%. Two patients are presented as case studies to describe how the pharmacist-health promoter team functioned. Information was obtained from health promoter records, survey results, and chart reviews. CONCLUSIONS: The pharmacist and health promoter team management of uncontrolled diabetes among Latinos appears to be a feasible approach to improving medication management.

Insulin pump therapy: guidelines for successful outcomes.

PURPOSE: Current forms of insulin delivery used in the treatment of diabetes mellitus (diabetes) include syringes, pens, and insulin pumps. Technical advantages of insulin pump therapy, or continuous subcutaneous insulin delivery (CSII), include precise and flexible insulin dosing. In the context of intensive diabetes management, insulin pumps can facilitate improved long-term glycemic control and reduce the risk for diabetes complications, with improved lifestyle flexibility for patients and their families. Comprehensive patient education, carbohydrate counting, and frequent self-monitoring of blood glucose or continuous glucose monitoring are necessary components of successful insulin pump therapy. Technological advances have increased the appeal of pump therapy to patients and clinicians. Physically, current insulin pumps are discreet, ergonomic, and water resistant. Meanwhile, software improvements have yielded smart pumps with features that support pump users in their daily diabetes management. Robust data analysis software packages allow patients and clinicians unprecedented insight into the quality of diabetes control. Furthermore, widespread insurance reimbursement for CSII has expanded access to therapy. CONCLUSIONS: As the number of pump users and potential users expands, diabetes educators face new challenges and opportunities to improve patients' lives with diabetes. This activity describes the rationale for insulin pump therapy, its potential advantages and disadvantages, and strategies regarding patient selection and education.