Diabetes Care Curriculum

 

The course will prepare pharmacists to improve and provide pharmaceutical care to diabetic patients.  Upon completion of the course, pharmacists will understand the pathophysiology of diabetes and the goals of therapy, and be able to assess and monitor diabetic patients, working with other healthcare providers to adjust medications and improve patient outcomes.

 

 

 

Hour

Topic

1

 

Jan 17

Course Introduction

- orientation to the course, participant expectations, etc.

This session will review the course operations and requirements.  At the conclusion of this session, pharmacist participants should be able to:

-  state the requirements for successful completion of the course

-  state the requirements for ACPE and certificate credit

-  access the internet course materials

 

INSTRUCTOR:  Peter J. Rice, PharmD, PhD

 

2

Pathogenesis of Diabetes

- development of disease

- pathological changes

- development of sequelae

- monitoring disease progression

This presentation will review diabetes as a disease, and the progression of the disease in the untreated or poorly treated patients.  General goals of therapy will be presented, particularly for blood glucose control; specific treatment recommendations for hypertension, cholesterol, ophthalmic and renal complications will be presented in later sessions.   At the conclusion of this session, participants should be able to:

-  describe the underlying pathology for type I and type II diabetes

-  describe the presentation of diabetes

-  describe the progression of diabetes

-   state the general treatment goals for diabetes  

 

INSTRUCTOR:  Alan N. Peiris , MD, PhD, MRCP, FACP, FACE

 

3

Epidemiology of Diabetes & Public Health Issues

Pharmacists and Diabetes - the Asheville Project

 

This presentation will review some of the research and epidemiological studies which underlie and support the provision of pharmaceutical care to diabetic patients and show that aggressive treatment of diabetes can improve quality of life and prolong patient survival.

-   review background supporting aggressive treatment of diabetes

-   define the objectives of pharmaceutical care of diabetics

-   state the major results of the Asheville Diabetes Project

 

INSTRUCTOR:  Michael Hayter – Wellmont

 

4

 

Jan 24

Diabetes Standards of Care

 

This session will prepare pharmacists to understand the current standard of care for diabetes patients and to monitor diabetic care.  At the conclusion of this session, participants should be able to:

-  state and explain the goals for diabetic care, including blood glucose control,  cholesterol, physician visits, lab testing, examination for co-morbidities, and immunization …

-  using a list of diabetic care requirements, review patient information and determine the need for diabetic care

-  develop a pharmaceutical care plan for diabetic patients

-  document services provided to diabetic patients

 

INSTRUCTOR:  Peter J. Rice, PharmD, PhD

 

5

Patient Assessment

 

This session will provide pharmacist participants with the background and skills to assess diabetic patients .  At the conclusion of this session, participants should be able to perform testing required for diabetes care, including:

-  scripted patient interview

-  blood pressure

-  weight

 

INSTRUCTOR:  TBA

 

 

6

Measurement of Blood Glucose

- counseling and use of glucose meters

- use of glucose meter software and

Analysis of blood glucose results and alteration of therapy

This presentation will review the changes in blood glucose which accompany diabetes, and monitoring of blood glucose.  At the conclusion of this session, participants should be able to:

-  state normal and diagnostic values for fasting and postprandial blood sugar

-  explain the physiologic control and clinical significance of hemoglobin A1C

-  graph typical 24 hour blood sugar levels in healthy, prediabetic and diabetic patients

-  appropriately instruct patients on sampling blood glucose, saving results to meter memory, and disposing of sharps

-  graph actual blood glucose values using meter software

-  recognize blood glucose values supporting alteration of therapy

 

INSTRUCTOR:  pharmacist needed

 

7

 

Jan 31

Reimbursement

MSHA Diabetes Care Program

Medicare Part D

Other Diabetes Programs

 

This session will provide the practical information needed to participate in diabetes care and apply for reimbursement.  Breakout sessions may be needed, based on the number of separate diabetes care programs.  At the conclusion of this session, participants should be able to:

-  state the participation requirements for the program(s)

-  state the patient contact / counseling requirements

-  file a claim for reimbursement

- 

 

INSTRUCTOR:  Timothy W. Coffey, PharmD (JCMCH)

 

 

8

LAB:  preparation and analysis of blood glucose results

 

This session will allow participants to gain experience with blood glucose meters and presentation of data.  Participants will collect their own blood glucose sample at defined times, save the results on a glucose meter, upload the results to computer, graph the results using meter software, create a report, and note recommendations for additional patient care.   Additionally, participants will obtain blood glucose results from a diabetic patient.

At the conclusion of this session, participants should be able to:

-  understand the burden of blood glucose measurement by patients

-  use a glucose meter and accompanying software

 

INSTRUCTOR:  TBA

 

9

Pharmacology of Insulins

 

This session will review the pharmacology of insulin in its various formulations and routes of administration.  At the conclusion of this session, participants should be able to:

-  state the pharmacological actions of insulin

-  recognize the activity differences between various insulins

-   graph the insulin activity over time for various insulins

-  describe two approaches for control of blood sugar by insulin

-

INSTRUCTOR:  Donald B. Hoover, PhD

 

10

 

Jan 31

Pharmacology of Oral Diabetic Medications

 

This session will review the pharmacology of drugs other than insulin for controlling blood glucose.  At the conclusion of this session, participants should be able to:

-  state the mechanism of action of each drug

-  describe the effect of each drug on blood glucose

-  state the pharmacological actions of each drug

-  describe the common adverse effects of each drug

-  describe how drugs are combined in effective drug therapy

- 

INSTRUCTOR:  Donald B. Hoover, PhD

 

11

Written Exam

12

Pharmacotherapy of Diabetes

- planning and adjusting insulin regimens

- planning and adjusting oral diabetes medications

 

This session will review the principles of using insulin and/or oral diabetic drugs to control blood glucose.  At the conclusion of this session, participants should be able to:

-  instruct patients on administering insulin

-   instruct patients on using oral diabetic medications

-  recognize appropriate pharmacotherapy for diabetes

-  recognize inappropriate pharmacotherapy for diabetes

-  make protocol-based recommendations for adjusting therapy

 

INSTRUCTOR:  pharmacist (preferred) or physician needed

13

Medication Review in Diabetes Care

 

This session will review the principles and practice of diabetes management in the presence of other disease states.  At the conclusion of this session, participants should be able to:

-  review patient medications to determine optimal therapy

-  recognize problem medications in diabetic patients

-  recognize additional treatment requirements for diabetic patients with concomitant disease states

-  make recommendations for initiating or adjusting pharmacotherapy

 

INSTRUCTOR:  Peter J. Rice, PharmD, PhD (tentative)

 

14

 

Feb 7

LAB:  planning and adjusting insulin and oral diabetic medications

 

This workshop session will allow participants to gain experience with monitoring patient blood glucose data and following protocols for patient care.  Pharmacist participants will receive four to six patient cases which may require intervention.  Additionally, participants will obtain similar data from their diabetic patient.

At the conclusion of this session, participants should be able to:

-  review patient data, including blood glucose measurements and effects of pharmacotherapy

-  identify problems and propose adjustments to pharmacotherapy

-  make protocol-based changes to therapy

-  counsel diabetic patients on their medications

 

INSTRUCTOR:  TBA

 

15

Diabetes Complications – cardiovascular

- special standards

- exercise plans

GOAL: know treatment standards,

 

This presentation will review cardiovascular aspects of diabetes, including CV complications of the disease and recommendations for treatment of hypertension and high cholesterol.  At the conclusion of this session, participants should be able to:

-  describe the cardiovascular effects of diabetes

-  state the goals of hypertension therapy in diabetic patients

-  state the goals of cholesterol therapy in diabetic patients

-  describe the role of exercise in various diabetic patients

-  interpret patient data and decide whether treatment goals are appropriate

-  interpret patient data and determine if goals are being met

-  counsel and refer patients to physician when appropriate

 

INSTRUCTOR:  Chris Downs, MD ??

 

16

Diabetes Complications – neuropathy

- how do we prevent and treat diabetic neuropathy

LAB:  patient case reports

 

This presentation will review neural aspects of diabetes, including

diabetic neuropathy and its complications, such as foot problems.  At the conclusion of this session, participants should be able to:

-  describe the effects of diabetes on nerve transmission

- 

-  interpret patient data and decide whether treatment goals are appropriate

-  interpret patient data and determine if goals are being met

-  

 

INSTRUCTOR:  TBA

17

 

Feb 14

Patient Assessment – skin care, wounds and feet

     Preferably with on-site patients

 

This session will allow participants to gain experience with monitoring patients with circulatory and neuropathic changes in the lower extremities.  Pharmacist participants will review two to four patients who may require intervention.  Additionally, participants will obtain similar data from their diabetic patient.

At the conclusion of this session, participants should be able to:

-  examine and assess patients with diabetic foot issues

-  recognize conditions requiring physician referral

-  counsel diabetic patients on foot care

 

INSTRUCTOR:  MSHA diabetes care nurse

 

18

Diabetic Nutrition

- counting carbs

- determining insulin requirements

- participants do calculations

- counseling patients on nutrition

 

This session will provide participating pharmacists with a modest background in nutrition, particularly as it relates to diabetic patients .  At the conclusion of this session, participants should be able to:

-  determine insulin requirements

-  perform calculations related to carbohydrates and insulin

-  counsel patients on nutrition and support nutritional recommendations of primary care providers

 

INSTRUCTOR:  Garren Woodby, PharmD, CDE  or  Timothy Coffey, PharmD

 

19

Diabetes Complications – nephropathy

- patient assessment and counseling

- how do we alter therapy

- what medications delay nephropathy

 

This presentation will review renal aspects of diabetes, including renal failure and electrolyte disturbances.

At the conclusion of this session, pharmacist participants should be able to:

-  describe the renal effects of diabetes

-  state the drugs that are appropriate for prevention of the renal complications of diabetes

-   describe the development of diabetic ketoacidosis, signs and appropriate medical response  

-  interpret patient data and decide whether treatment goals are appropriate

-  interpret patient data and determine if goals are being met

 

INSTRUCTOR:  Leslie W. Panus, MD

 

20

 

Feb 21

Diabetes Complications – ocular

     - how do pharmacists manage diabetes patients

 

This presentation will review ophthalmic aspects of diabetes, including complications of the disease and recommendations for treatment of ocular disorders in diabetic patients. At the conclusion of this session, pharmacist participants should be able to:

-  describe the ophthalmologic effects of diabetes

-  state standards for ocular exams and treatment in diabetic patients

-  counsel patients on common eye problems

-   recognize ocular problems that require physician referral

- 

 

INSTRUCTOR:  TBA

 

21

Successful patient counseling

 

This session will provide inspiration and ideas that will enable and encourage pharmacists to improve pharmaceutical care to diabetic patients.  At the conclusion of this session, participants should be able to:

-  develop a diabetes care plan using previous knowledge

-  successfully encourage patients to improve their management of diabetes

-  document provided services

 

INSTRUCTOR:  TBA

 

22

Improving patient compliance in diabetes patients

 

This session will .  At the conclusion of this session, participants should be able to:

-  state some techniques for motivating patients with diabetes

-  improve patient compliance through counseling, referral and monitoring of therapy

 

INSTRUCTOR:   TBA

 

23

Written Exam

24

Practical Exam

 

25

-

30

 

 

up to an additional credit (6 hrs) for course readings and projects

 

 

 

The course will be offered through the ETSU Pharmacy Continuing Education program.  It will be approximately 30 hours in length, including reading assignments, and will be offered as a weekly live evening course of three hours over eight weeks.  There will be two written exams and a practical exam consisting of two patient cases requiring intervention and counseling by pharmacist participants.  All participants will receive pharmacy continuing education credit; pharmacists successfully completing the written and practical exams will receive additional credit as an ACPE certificate course. 

 

The course materials will be available on a blackboard website to allow students to access reading materials and slide-audio lectures during the course. 

 

 

Faculty

Faculty will include basic scientists and clinical practitioners with expertise in diabetes and diabetes care.  Ideally, faculty will provide both scientific and practical expertise in a teaching format that actively involves participants and encourages the development of critical thinking skills and sound clinical judgment. 

 

 

 

 

Readings  (tentative)

 

Medical Letter Treatment Guidelines (2002) and (2005)

Medical Letter (2006) Glulisine insulin

Asheville Project Papers - JAPhA (2003)

Am J Health-Syst Pharm formulary reviews

 

Treatment Guidelines

     diabetes

        diabetic neuropathy

        diabetic nephropathy

     cholesterol

     hypertension

     heart failure