Pharmacy U

The 360-approach to diabetes management

Rob Roscoe2

Diabetes has reached epidemic proportions in Canada. It’s time to take a 360-approach to achieve results.

By donalee Moulton

Photography by David Connell

According to the Canadian Diabetes Association, 11 million Canadians are currently living with diabetes or prediabetes—a condition which, if left unchecked, puts you at risk of developing type 2 diabetes. By 2020, that number is expected to rise to one in three.

Many of those diagnosed with diabetes will have questions – and they will turn to their pharmacists for information. “This is a primary care issue, but family doctors don’t have a lot of time. We are more accessible and at times can pick up on issues and concerns sooner,” says Rob Roscoe, a Certified Diabetes Educator and pharmacist with more than 30 years’ experience working at a small, independent pharmacy in Rothesay, NB.

Recent studies demonstrate that when a pharmacist caring for a person living with diabetes works in collaboration with other members of their healthcare team, there are improvements in A1C, a test that measures average blood glucose control over a period of two to three months.

In addition, studies have found there are also improvements in A1C (a test that measures average blood glucose (sugar) control over a period of two to three months), plus reductions in medication reactions and cholesterol, notes Carolyn Gall Casey, director of education with the Canadian Diabetes Association. “Pharmacists can provide people living with diabetes self-management education and support to help them achieve their individual goals.”

Pharmacists should not wait to provide that support. Being proactive can help patients address issues early and even prolong the need for medication, says Stacey Smith, a Certified Diabetes Educator and pharmacist with Valley Drug Mart in Middle Sackville, NS. “People appreciate your help. They’re grateful that you are looking out for them.”

Clinics are an effective way to reach a larger number of patients and help reinforce your pharmacy’s expertise in this area. Diabetes Health Awareness Days, for example, are an opportunity to provide one-on-one counseling. Smith usually holds 20-minute sessions with individuals and starts with an overview of non-pharmacological options. This includes a discussion of weight loss and nutrition, primarily a review of Canada’s Food Guide.

Foot clinics are another helpful and visible way to reach your diabetic patients and their families. A public health nurse can be brought in for these events. The issue of foot care, however, should be routinely addressed with patients. “Ask about their feet and if they are having any problems. This is particularly important heading into the summer months,” says Smith.

Roscoe holds what he calls Options Clinics, individual counselling with patients to review their medications and discuss their “next steps”. “I provide them with their options, help them sort through the information, and assist the patient in developing a plan of action.”

In addition, he makes certain every patient understands how to use an insulin injector even if the drug has not been prescribed. Each person does a dry injection, which helps to remove some of the fear associated with the process. “Everyone is surprised at how easy it is and how discreet it is, as well as the fact that it doesn’t really hurt,” he says.

“This calms people down,” Roscoe adds. “Then we can have a realistic discussion about all the options available.”

Smith recommends starting small and helping patients to set practical, attainable goals. A five per cent weight loss, for example, is achievable for most patients and less intimidating. “Start small and build. Tackle dietary changes one step at a time,” she advises.

Pharmacists are a source of information even when they aren’t directly counselling a patient. Material on foot care, nutrition and other issues can be included with prescriptions, to be read later. Brochures on the front counter can be picked up easily, and the Canadian Diabetes Association has a wealth of information on their website; pharmacists can help distribute or refer to their patients. Smith recommends creating a diabetes checklist that patients can pick up when they are in the store. It includes things such as the need for an annual eye exam.

“There are lots of opportunities available to help patients with diabetes,” says Smith. “It’s important to reach out to them.”


Diabetes care checklist


1.  Collaborate. Working as part of a healthcare team helps patient outcomes.

2. Offer in-store diabetes clinics as well as private counselling sessions, covering a range of subjects, from using an insulin pump to maintaining the best diet and exercise regime.

3.  Look for opportunities to leverage frontshop sales. There are a number of products and product categories of interest to patients with diabetes. Link your counselling with sales of these related items.

4.  Hand out materials or direct your patients to the Canadian Diabetes Association site ( for up-to-date information.

5.  Offer a holistic approach. Diabetes and pre-diabetes involves not only Rx, but also ancillary products, such as foot care and diet-related items.