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1. Role of Pharmacist Management and Novel
Therapies of Diabetic Nephropathic Patients
K.P. Sampath Kumar*, DebjitBhowmik, Lokesh Deb, ShravanPaswan,2012
It has been predicted that worldwide the prevalence of diabetes in adults would increase to
5.4% by the year 2025 from the prevalence rate of 4.0% in 1995. Consequently the number of
adults with diabetes in the world would rise from 135 million in 1995 to 300 million in the year
2025. It is expected that much of this increase in prevalence rate will occur in developing
countries. While a 42% increase is expected in developed countries, a 170% increase is expected
in the developing countries
Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys
caused by diabetes. In severe cases it can lead to kidney failure. But noteveryone with diabetes
has kidney damage .The kidneys have many tiny blood vessels that filter waste from yourblood.
High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able
to do its jobas well. Later it may stop working completely. This is called kidney failure. Certain
things make you more likely toget diabetic nephropathy.
Diabetes can affect many parts of the body, including the kidneys. In healthy kidneys, many tiny
blood vessels filter waste products from your body. The blood vessels have holes that are big
enough to allow tiny waste products to pass through into theurine but are still small enough to
keep useful products (such as protein and red blood cells) in
the blood. High levels of sugar in the blood candamage these vessels if diabetes is not
controlled.This can cause kidney disease, which is alsocalled nephropathy (say: nef-rah-puh-
thee). If thedamage is bad enough, your kidneys could stopworking.
There are no symptoms in the early stages. So its important to have regular urine tests to find
kidney damage early. Sometimes early kidney damage can be reversed. The first sign of kidney
damage is a small amountof protein in the urine, which is found by a simple urine test. As
damage to the kidneys gets worse, your bloodpressure rises. Your cholesterol and triglyceride
levels rise too. As your kidneys are less able to do their job, youmay notice swelling in your
body, at first in your feet and legs. Community pharmacist can take to increase theirinvolvement
and contribution to public health at a local level in collaboration with other public health. During
thisrole shift, the competency of community pharmacists is in higher demand than ever before. In
view of availability ofnumerous new medicines and drug delivery systems, community
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pharmacists are challenged to ensure that patientsget maximum benefit from their medicines. It is
essential that discovery of new drug, new therapeutics effect ofelatively older drugs, clinical
trials, toxicological studies etc. are all carried out involving community pharmacy at
different phases.
Diabetic nephropathy has been categorized into stages: microalbuminuria and macroalbuminuria.
If abnormal, it should beconfirmed in two out three samples collected in a
three to six-months interval. Additionally, it isrecommended that glomerular filtration rate be
routinely estimated for appropriate screening ofnephropathy, because some patients present
adecreased glomerular filtration rate when urinealbumin values are in the normal range.
The twomain risk factors for diabetic nephropathy arehyperglycemia and arterial hypertension,
but thegenetic susceptibility in both type 1 and type 2diabetes is of great importance. Other risk
factorsare smoking, dyslipidemia, proteinuria,glomerular hyperfiltration and dietary factors
In patients with type 2 diabetes, renal lesions are heterogeneous andmore complex than in
individuals with type 1diabetes. Treatment of diabetic nephropathy isbased on a multiple risk
factor approach, and the goal is retarding the development or progressionof the disease and to
decrease the subject'sincreased risk of cardiovascular disease
Signs and Symptoms of DiabeticNephropathyDiabetes can affect many parts of the body,including the kidneys. In healthy kidneys, manytiny blood vessels filter waste products from yourbody. The blood vessels have holes thatare bigenough to allow tiny waste products to passthrough into the urine but are still smallenoughto keep useful products (such as protein and redblood cells) in the blood. High levelsof sugar inthe blood can damage these vessels if diabetes isnot controlled. This can cause kidney disease,which is also called nephropathy (say: nef-rahpuh-thee). If the damage is bad enough, yourkidneys could stop working. Early signsandsymptoms of kidney disease in patients withdiabetes are typically unusual. However, avastarray of signs and symptoms listed below maymanifest when kidney disease hasprogressed
Albumin or protein in the urine
High blood pressure
Ankle and leg swelling, leg crampsGoing to the bathroom more often at night
High levels of blood urea nitrogen (BUN)
and serum creatinine
Less need for insulin or antidiabetic
medications
Morning sickness, nausea, and vomiting
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Weakness, paleness, and anemiaItching
2
Lifestyles which have been established for many years are not easy to change
and health care professionals cannot expect immediate adherence to the plan
of management. Assess the SNAP risk factors (Smoking, Nutrition, Alcohol and Physical
activity) and establish a long term lifestyle plan.
It is important for the patient to have all the information available so thata common sense of purpose between the health care professionals and the patient can
develop. This takes time and some patients may decide to reject advice.
Professionals need to maintain an open approach and emphasise that help
is available when required.
Weight reduction is often difficult. A combined program of healthy eating, physical
activity and education directed at behavioural changes is often successful. Carer and
peer encouragement helps these behavioural changes.
Health care professionals need to be sensitive to patient views concerning
diabetes and be ready to counsel. The normal stresses of daily living can
affect diabetes control. Seek opportunities to help patients regain control,
to improve self esteem and to understand and control their condition.
There is a range of approved educational materials produced by State and TerritoryDiabetes Organisations which can be recommended to the newly diagnosed person
with diabetes.
Education is ongoing and needs to continue for the rest of the persons life. Diabetes
knowledge, especially self care skills (blood glucose monitoring, foot care, insulin
administration) need to be assessed regularly (eg: as part of the complication screen
at the twelve monthly review).
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3.Diabetes education and knowledge in patients with type 2 diabetes from the communityThe Fremantle Diabetes Study
David G. Brucea,*, Wendy A. Davisa,b, Carole A. Cullc, Timothy M.E. Davisa, 2003
Provide education
1. Diabetic patients obtain knowledge of the condition from a variety of sources. These
include education programs and
encounters with health-care staff such as during instruction on self-monitoring of blood glucose
(SMBG).
Diabetes education programs,
diabetes-related visits to dieticians and SMBG are associated with, and may be important sources
of, improved diabetes knowledge in
patients with type 2 diabetes.
2. Problems: Our data provide evidence that barriers to access or utilization ofcontemporary diabetes education confront
older patients, minority groups and those with language difficulties
3. Adequate knowledge of diabetes is a key component of
diabetes care (Beaser, Richardson, & Hollerworth, 1994).
The potential benefits of diabetes knowledge include a sense
of empowerment and improved quality of life (Beaser et al.,
1994; Brown, 1990; Padgett, Mumford, Hynes, & Carter,
1988). While it has been difficult to demonstrate that formal
diabetes education per se leads to improved metabolic
control (Lockington, Meadows, & Wise, 1984), it is clear that improvements in outcomes cannot
occur without
adequate instruction about diabetes (Beaser et al., 1994).
To this end, all people with diabetes are encouraged by the
American Diabetes Association to attend formal diabetes
education programs (Department of Health and Human
Services, 1991).
4. Information about diabetes is obtained from a variety of
sources including one-to-one interactions with doctors,
nurses and dieticians. Self-monitoring of blood glucose
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(SMBG) requires considerable instruction and could be an
important additional source of diabetes knowledge for many
patients. The value of SMBG in patients with type 2 DMwho
are not on insulin treatment has been questioned because of
doubts about beneficial effects on glycemic control (Evans
et al., 1999; Faas, Schellevis, & Van Eijk, 1997; Kennedy, 2001)
5. instruction was associated with the highest knowledge
scores. Where patients had been exposed to only two of
these activities, diabetes education provided a more important
contribution to knowledge than SMBG or dietetic advice
6. Alternatively, those who attend programs
already have the qualities of adherence that are helpful in
improving their self-management behaviors. Many studies
have found little or no relationship between knowledge and
behavior (Beaser et al., 1994; Lockington et al., 1984),
while it has been repeatedly demonstrated that diabetes
education programs lead to gains in diabetes knowledge
(Brown, 1990; Karlander & Kindstedt, 1983; Padgett et al.,1988) as reflected by the present data.
Diabetes
7. The experience of living with insulin-dependent diabetes:lessons for the diabetes
educator
Hernandez, C.A., 1995
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8. The Scope of Practice of Diabetes Educators in a Metropolitan Area
Mariorie Cypress, Judith Wylie-Rosett, Samuel S. Engel and Terry B. Stager,1992
Other health care professionals as diabetes educator.
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The responses of the registered nurse and registered dietitian respondents, contribute to
the most as diabetic education.more than 75% of the nurses performed 5 of the educator
roles
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