Johnson L C, Beach E
West County Internal Medicine, St. Louis, MO 63141, USA.
Pharm Pract Manag Q. 1997 Oct;17(3):32-44.
The role of the pharmacist on the diabetes care team is expanding due to the increasing number of patients diagnosed with diabetes, limited health care dollars, and the education related to and required for patients by managed care organizations and insurance companies. In the past, training of patients in diabetes self-management skills has been inadequate, and this continues to be the case. Clinical pharmacists, in cooperation with physicians, have increased opportunities to provide education about medications and may include instructions for patients regarding the interaction of food consumed with changes in blood glucose levels. Because of monthly refills on prescribed medications, a patient's interaction with the pharmacist in the setting of a commercial pharmacy is more frequent than with any other member of the diabetes team. This contact offers an ideal educational opportunity. The action and efficacy of medications that affect the pancreas, hepatic glucose production, the utilization of glucose by muscle cells, and the absorption of glucose from the intestines are influenced directly by the meal plan. Nutritional guidelines, meal planning for the Type I and Type II patient, use of the exchange system, carbohydrate counting, artificial sweeteners, alcoholic beverages, and suggestions for guiding patients to establish eating habits that lead to improved diabetes control are important issues for every member of the diabetes team to address. The reinforcement of dietary principles may occur in the educational setting of the hospital or the clinic or within the commercial pharmacy setting. When the team presents accurate and current information, continuity of care and improved patient understanding are achieved.
由于糖尿病确诊患者数量不断增加、医疗保健资金有限，以及管理式医疗组织和保险公司对患者的相关教育要求，药剂师在糖尿病护理团队中的作用正在不断扩大。过去，对患者糖尿病自我管理技能的培训一直不足，目前仍是这种情况。临床药剂师与医生合作，有更多机会提供药物方面的教育，可能还会为患者提供有关所摄入食物与血糖水平变化之间相互作用的指导。由于处方药需要每月补充，患者在商业药房与药剂师的互动比与糖尿病护理团队的其他任何成员都更频繁。这种接触提供了一个理想的教育机会。影响胰腺、肝脏葡萄糖生成、肌肉细胞对葡萄糖的利用以及肠道对葡萄糖吸收的药物的作用和疗效直接受饮食计划影响。营养指南、I型和II型患者的饮食计划、交换系统的使用、碳水化合物计数、人工甜味剂、酒精饮料，以及指导患者养成有助于改善糖尿病控制的饮食习惯的建议，是糖尿病护理团队的每个成员都要解决的重要问题。饮食原则的强化可以在医院或诊所的教育环境中进行，也可以在商业药房环境中进行。当团队提供准确和最新的信息时，就能实现护理的连续性并提高患者的理解。
