the community pharmacist's role in diabetes treatment
TRANSCRIPT
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
1/23
]`d Fieetko}y S`hrehfov}v
Rind ok Mohbd}dv ]rdh}edk}By Aoebdrny Gdrdkfd. S`hreM
sik fiesnd}oik i }`ov hf}owo}y.
}`d s`hrehfov} v`itnm bd hbnd }i
hf`odwd }`dvd mordf}owdv64 ej)mN hkm }rojnyfdromdv
;243 ej)mN/
@ov}iry ig jdv}h}oikhn mohbd}dv ir mdnowdry ig h bhby
zdoj`okj ; ? nbv
@ov}iry ig fhrmoiwhvftnhr movdhvd (FWM/
@ov}iry ig sinyfyv}of iwhry movdhvd
I}`dr fikmo}oikv zo}` okvtnok rdvov}hkfd
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] 2?
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
2/23
by okvtnok mdfodkfy+ Nikj%}dre ysdrjnyfdeoh hv bddk
v`izk }i okfrdhvd }`d rova i mdwdnisokj mohbd}dv%rdnh}dm
fiesnofh}oikv+ ]`drd hrd itr modrdk} fnhvvofh}oikv i
mohbd}dv< }ysd 8. }ysd 2. jdv}h}oikhn. hkm vdfikmhry (hv
h rdvtn} i jdkd}of fikmo}oikv. edmofh}oikv. hkm whroitv
i}`dr fhtvdv/+ H nov} i rova hf}irv ir }`d mdwdnisedk} i
mohbd}dv fhk bd itkm ok }`d bip ik shjd 2?+
Okvtnok ov hk dkmijdkitv `ireikd }`h} ov rdndhvdm
rie bd}h fdnnv nifh}dm ok }`d shkfrdhv ok rdvsikvd }i
dndwh}dm snhveh jntfivd+ Ok sh}odk}v zo}`it} mohbd}dv.
okvtnok v}oetnh}dv fhrbi`ymrh}d ed}hbinove hkm hfono}h}dv
}rhkvdr i jntfivd ok}i fhrmohf hkm vadnd}hn etvfnd hkm
hmosivd }ovvtd. hkm fikwdr}v jntfivd ok}i jnyfijdk (}`d
v}irdm ire i bniim vtjhr/+ Hk hbvint}d okvtnok md%
fodkfy hrovokj rie bd}h fdnn mdv}rtf}oik ov rdvsikvobnd
ir }`d hmwdrvd f`hkjdv ok jntfivd fik}rin vddk ok }ysd 8
mohbd}dv (irehnny akizk hvltwdkond mohbd}dv irokvtnok%mdsdkmdk} mohbd}dv ednno}tv/+ Hn}`itj` }`d vitrfd i bd}h
fdnn mdv}rtf}oik ov ki} tnny tkmdrv}iim. o} ov }`itj`} }i bd
ht}ioeetkd ok kh}trd+
Dndwh}dm snhveh jntfivd fikfdk}rh}oikv }`h} ifftr
ok }ysd 2 mohbd}dv (irehnny akizk hvhmtn} ikvd} mohbd}dv
irkik%okvtnok%mdsdkmdk} mohbd}dv ednno}tv/ hrd fhtvdm
by h fiebokh}oik i okvtnok rdvov}hkfd hkm okhmdxth}d
fiesdkvh}iry okvtnok vdfrd}oik ok rdvsikvd }i h edhn+
Okvtnok rdvov}hkfd srdmieokhk}ny ifftrv z`dk okvtnok%
edmoh}dm jntfivd ts}had by }`d nowdr honv+ ]`ov rdvtn}v okh fiesdkvh}iry iwdrsrimtf}oik i jntfivd hkm }`drdird
okfrdhvdv bniim jntfivd fikfdk}rh}oik+ Oeshordm okvtnok
vdfrd}oik ifftrv z`dk }`d shkfrdhv fik}oktitvny sri%
mtfdv okvtnok ok hk dir} }i ehok}hok dtjnyfdeoh (kirehn
heitk}v i bniim jntfivd/. rdvtn}okj ok `ysdrokvtnokdeoh+
O} ov }`ov dndwh}dm heitk} i okvtnok ok }`d forftnh}oik }`h}
kdjh}owdny hdf}v }`d tkf}oik i }`d shkfrdh}of bd}h fdnnv
by mdfrdhvokj tr}`dr okvtnok vdfrd}oik+ ]`tv okfrdhvdm
okvtnok fikfdk}rh}oikv tn}oeh}dny rdvtn} ok nivv i bd}h%fdnn
edmoh}dm fiesdkvh}iry okvtnok vdfrd}oik ok rdvsikvd }i
edhnv. ndhmokj }i oeshordm jntfivd }indrhkfd+I}`dr edf`hkovev fik}robt}d }i ehok}dkhkfd i jny%
fdeof fik}rin+ Tkmdr kirehn s`yvoinijof forftev}hkfdv.
jntfhjik%noad sds}omd 8 (JNS%8/. hk dkmijdkitv okfrd}ok
`ireikd. ov rdndhvdm by }`d ok}dv}okd }`ritj`it} }`d mhy+
]`dvd ndwdnv okfrdhvd ok rdvsikvd }i giim ok}had+ JNS8
rdjtnh}dv jntfivd `iediv}hvov by h whrod}y i edhkv. ok%
fntmokj okfrdhvokj okvtnok srimtf}oik hkm }`d rdndhvd rie
shkfrdh}of bd}h fdnnv. hkm vnizokj i jhv}rof des}yokj hkm
mdfrdhvdm iim ok}had+ Jntfhjik%noad sds}omd8
hnvi mdfrdhvdv okhssrisroh}d shkfrdh}of hns`h
fdnn vdfrd}oik i jntfhjik. z`of` okfrdhvdv
`dsh}of jntfivd srimtf}oik ok rdvsikvd }i niz
bniim jntfivd+ ]`d dk|yed mosds}omyn sds}o%
mhvd%= (MSS%=/ rhsomny okhf}owh}dv JNS%8+ Mohbd%
}dv edmofh}oikv mdwdnisdm ok rdfdk} ydhrv `hwd
}hrjd}dm }`d JNS%8 sh}`zhy+ ]`dvd edmofh}oikv
hf} by ok`obo}okj JNS%8 dk|yeh}of okhf}owh}oik
(MSS%= ok`obo}irv/ ir htjedk}okj }`d dggdf}v ig
dkmijdkitv okfrd}ok (JNS%8 hjikov}v/+
VFRDDKOKJ HKM MOHJKIVOV
]`d HMH rdfieedkmv vfrddkokj ir mohbd}dv
v}hr}okj h} hjd =4 ok }`ivd zo}`it} rova hf}irv+
O }`d vfrddkokj rdvtn}v hrd kirehn. }`d sh}odk}
v`itnm bd rdhvvdvvdm dwdry }`rdd ydhrv. }haokjok}i hffitk} f`hkjokj rova hf}irv hkm `dhn}`
v}h}tv+ Dhrnodr }dv}okj v`itnm bd fikvomdrdm o
}`d sh}odk} ov iwdrzdoj`} hv fnhvvodm by BEO
hkm `hv hmmo}oikhn rova hf}irv hv mdvfrobdm ok
]hbnd 8+ Mohbd}dv vfrddkokjv }`h} }had snhfd ok
h fieetko}y s`hrehfy fhk vdrwd hv h srd%
vfrddkokj hkm `dns }i omdk}oy sh}odk}v z`i
i}`drzovd zitnm ki} `hwd bddk vfrddkdm+
]`drd hrd vdwdrhn modrdk} ed}`imv tvdm
}i ehad h mohjkivov ig mohbd}dv+ Sroir }i }`drdndhvd i }`d 2383 V}hkmhrmv i Fhrd. `dei%
jnibok H8F (H8F/ zhv ki} rdfieedkmdm by
}`d HMH hv h mohjkiv}of fro}droik bdfhtvd i
}`d nhfa i hvvhy v}hkmhrmo|h}oik. hkm }`drdird
xtdv}oikhbnd hfftrhfy+ Vokfd }`d mdwdnisedk}
i }`d Kh}oikhn Jnyfi`deijnibok V}hkmhrmo|h%
}oik Srijrhe (KJVS/. }`d HMH kiz dkmirvdv
}`d tvd i H8F hv h mohjkiv}of is}oik+ Hk H8F
i 7+4 sdrfdk} ov fikvomdrdm mohjkiv}of hkm
v`itnm bd fikgredm by h vdfikm }dv} ik h
vtbvdxtdk} mhy+ Ftrrdk}ny. siok}%ig%fhrd (SIF/
mdwofdv v`itnm ki} bd tvdm z`dk hvvojkokj
H8F ir mohjkivov. hv }`dy hrd ki} v}hkmhrmo|dm+
Ikd hmwhk}hjd }i tvokj H8F hv h mohjkiv}of
ehradr ov }`h} }dv}okj midv ki} rdxtord hv}okj+
I}`dr mohjkiv}of ed}`imv okfntmd h hv}okj
(h} ndhv} doj`} `itrv/ snhveh jntfivd i 827
ej)mN ir hk irhn jntfivd }indrhkfd }dv} (IJ]]/
zo}` h }zi%`itr snhveh jntfivd i 233 ej)
63 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
3/23
mN+ ]`d IJ]] okfntmdv h :4 j jntfivd nihm
hkm v`itnm bd ok fiesnohkfd zo}` }`d Zirnm
@dhn}` Irjhko|h}oikv v}hkmhrmv+ Bi}` ig }`d
}dv}v rdxtord fikreh}oik by rdsdh} }dv}okj ik
h vtbvdxtdk} mh}d+ H rhkmie snhveh jntfivd
i 233 ej)mN ifftrrokj ok h sh}odk} movsnhyokj
fnhvvof vyes}iev i `ysdrjnyfdeoh (vtf` hv
sinytroh. sinys`hjoh. ir sinymosvoh/ zitnm hnvi
edd} }`d fro}droh ir h mohjkivov i mohbd}dv+
]`ov }dv} midv ki} kddm }i bd rdsdh}dm+ Vtbvd%
xtdk}ny. srdmohbd}dv ov fikvomdrdm z`dk hv}okj
snhveh jntfivd ov 833824 ej)mN. ir h }zi%
`itr snhveh jntfivd mtrokj hk irhn jntfivd
}indrhkfd }dv} ov 8=38?? ej)mN+ Hk H8F ig
4+:7+= sdrfdk} ov hnvi fikvomdrdm srdmohbd}dv+
]RDH]EDK] JIHNV IG ]@DRHS_Iwdrhnn mohbd}dv }rdh}edk} jihnv okfntmd
rdmtfokj rova ir mdwdnisedk} i nikj%}dre
eofriwhvftnhr hkm ehfriwhvftnhr fiesnofh%
}oikv. mdfrdhvokj mohbd}dv rdnh}dm eirbomo}y
hkm eir}hno}y. srdwdk}oik i hft}d fiesnofh}oikv
fhtvdm by fik}oktdm `ysdrjnyfdeoh. srdwdk%
}oik ig `ysijnyfdeof dsovimdv. hkm oesriwokj)
ehok}hokokj xthno}y i nod+ ]`dvd jihnv v`itnm
bd okfirsirh}dm ok}i }`d fhrd snhk hkm rdxtdk}%
ny rdwovo}dm zo}` }`d sh}odk} hv h shr} i rdjtnhrvdn%ehkhjdedk} vdvvoikv+
Jnyfdeof fik}rin ov hvvdvvdm }`ritj` }`d
edhvtrdedk} i H8F hkm fhsonnhry snhveh
jntfivd. hkm vdn%eiko}irokj bniim jntfivd
(VEBJ/ whntdv+ I }`dvd }dv}v. VEBJ ov }`d
ndhv} hfftrh}d1 `izdwdr. o} ov eird fikwdkodk}
hkm ndvv okwhvowd }`hk }`d i}`drv+ Vdn%eiko}ir%
okj bniim jntfivd ov bdkdfohn hv h edhkv }i
vdn hvvdvv jnyfdeof fik}rin hkm hvvov} ok }`d
dwhnth}oik hkm srdwdk}oik i `ysijnyfdeoh+
]`d HMH rdfieedkmv }dv}okj }`rdd ir eird}oedv mhony ok sh}odk}v tvokj etn}osnd mhony ok%
vtnok okldf}oikv hkm okvtnok stesv+ Gir sh}odk}v
zo}` mohbd}dv ki} tvokj okvtnok. }`d eiko}irokj
rdxtdkfy ov ki} zdnn mdkdm hkm dwomdkfd i
bdkd} ov fik}riwdrvohn+ Hn}`itj` vied v}tm%
odv vtjjdv} rdxtdk} eiko}irokj ndhmv }i nizdr
H8F whntdv hkm bd}}dr iwdrhnn it}fiedv. }`drd
ov hnvi dwomdkfd }`h} vtjjdv}v rdxtdk} eiko%
}irokj rdmtfdv xthno}y i nod zo}`it} oesriwokj jnyfdeof
fik}rin+ Vied `dhn}` fhrd sriwomdrv xtdv}oik }`d fiv}%
ddf}owdkdvv hkm fnokofhn vojkofhkfd i rdxtdk} VEBJ
ok sh}odk}v ki} t}ono|okj okvtnok+ Ndvv v}rokjdk} eiko}irokj
ehy bd rdfieedkmdm ir }`dvd sh}odk}v. hkm v`itnm bd
okmowomthno|dm bhvdm ik sh}odk} kddm+ Jihnv ir snhveh
jntfivd hrd onntv}rh}dm ok ]hbnd 8+
]`d HMH hkm Hedrofhk Hvvifoh}oik i FnokofhnDkmifrokinijov}v (HHFD/)Hedrofhk Finndjd ig Dkmi%
frokinijov}v (HFD/ modr vnoj`}ny ok }`dor rdfieedkmh%
}oikv ir H8F jihnv+ Hvvdvvedk} i H8F v`itnm bd
sdriredm dwdry }`rdd eik}`v ir sh}odk}v ki} edd}okj
jnyfdeof jihnv. hkm h} ndhv} }zofd ydhrny ir }`ivd z`i
hrd fik}rinndm+ Vdwdrhn fnokofhn }rohnv `hwd mdeikv}rh}dm
}`h} }oj`} jnyfdeof fik}rin rdmtfdv fhrmoiwhvftnhr rova
hkm srdwdk}v }`d mdwdnisedk} i eofriwhvftnhr fie%
snofh}oikv+ Ok fik}rhv}. }`d Hf}oik }i Fik}rin Fhrmoiwhv%
ftnhr Rova ok Mohbd}dv (HFFIRM/ }rohn mdeikv}rh}dmhk okfrdhvd ok eir}hno}y ok sh}odk}v rdfdowokj ok}dkvowd
jntfivd nizdrokj+ O} hssdhrv }`h} }oj`} jntfivd fik}rin
ehy okfrdhvd ir mdfrdhvd rova mdsdkmokj ik sh}odk}%
vsdfof hf}irv hkm }ysd i }`drhsy hmeokov}drdm+
Ehok}hokokj hk H8F i hssripoeh}dny : sdrfdk} ov
hssrisroh}d. bhvdm ik }`d fikgof}okj mh}h vtrritkmokj
rova. hkm H8F jihnv v`itnm bd okmowomthno|dm+ ]`d HMH
rdfieedkmv ndvv v}rokjdk} H8F jihnv (o+d+. : sdr%
fdk}/ ir }`d innizokj sh}odk}v< }`d dnmdrny. }`ivd h} rova
ir }`ivd zo}` h `ov}iry i vdwdrd `ysijnyfdeoh. nikj%
v}hkmokj moftn}%}i%fik}rin mohbd}dv. vdwdrhn fieir%bomo}odv. hkm mdfrdhvdm nod dpsdf}hkfy+
]`d HMH rdfdk}ny dkmirvdm tvokj h kdz }dv} }`h} ov
rdfieedkmdm z`dk movftvvokj jntfivd fik}rin zo}` sh%
}odk}v+ Dv}oeh}dm hwdrhjd jntfivd (DHJ/ ov tvdm ok fik%
ltkf}oik zo}` H8F }dv}okj. hkm eiv} nhbirh}irodv sriwomd
hk DHJ z`dk hk H8F ov irmdrdm+ O} ov }`itj`} }i bd eird
tkmdrv}hkmhbnd z`dk movftvvokj nhbirh}iry eiko}irokj
zo}` sh}odk}v. hv o} firrdnh}dv zo}` sh}odk} VEBJ whntdv+
]hbnd 8< Jihnv ir Jnyfdeof Fik}rin
]dv} HMH Jihn HFD hkm
HHFD Jihn
H8F >:$ >7+4$
Dv}oeh}dm hwdrhjd jntfivd >84= ej)mN >8=3 ej)mN
Srdsrhkmohn snhveh jntfivd :3%863 ej)mN >883 ej)mN
Siv}srhkmohn snhveh jntfivd >803 ej)mN >8=3 ej)mN
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] 68
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
4/23
I}`dr jihnv i }`drhsy okfntmd h bniim srdvvtrd i
>863)03 ee@j hkm h niz%mdkvo}y nosisri}dok ndwdn ig
>833 ej)mN ok eiv} (> :3 ej)mN ok }`ivd zo}` h `oj`
rova gir fhrmoiwhvftnhr movdhvd/+ Srdwdk}oik hkm eiko}ir%
okj ir ehfriwhvftnhr fiesnofh}oikv. okfntmokj ysdr}dk%
voik hkm myvnosomdeoh. hrd movftvvdm nh}dr ok }`d srdwdk%
}oik hkm eiko}irokj ir fiesnofh}oikv vdf}oik+
NOGDV]_ND EIMOGOFH]OIKV
]`d Kh}oikhn Mohbd}dv Vdn%Ehkhjdedk} Dmt%
fh}oik ]hva Girfd mdvfrobdv MVED hf}owo}odv
hv }`d hvvdvvedk} i }`d okmowomthnv vsdfof
dmtfh}oik kddmv. omdk}ofh}oik i }`d okmowomt%
hnv vsdfof mohbd}dv vdn%ehkhjdedk} jihnv.
dmtfh}oik hkm bd`hwoirhn ok}drwdk}oik mordf}dm
]hbnd 2< Hwhonhbnd Irhn Hjdk}v
Fnhvv Jdkdrof Khed Brhkm Khed V}hrokj mivd Ehpoete
Mhony
Mivd ,
Hmltv}edk}v
ir Rdkhn)
@dsh}of
Oeshoredk}
Srdj%
khkfy
Fh}djiry
Bojthkomdv Ed}ireok
Ed}ireok DR
Jntfis`hjd
Roied}
Gir}hed}
Jntfis`hjd
PR
Jnted}|h
433 ej ikfd
}i }zofd mhony
ir 043 ej
ikfd mhony4338.333 ej
ikfd mhony
2.443 ej
2.333 ej
Rdkhn < Hwiom
@dsh}of< Ki}
rdfieedkmdm
B
2km Jdkdrh}oik
vtnikyntrdhv
Jnybtromd
(eofriko|dm/
Jnoso|omd
Jnoedsoromd
Eofrikhvd
MohBd}h
Jnykhvd
Jntfi}rin
Jntfi}rin PN
Hehryn
2+44 ej ikfd
}i }zofd mhony
2+44 ej ikfd
}i }zofd mhony
8+4 }i 6 ej
mhony
4 ej ikfd }i
}zofd mhony4 ej mhony
8 2 ej mhony
23 ej
23 ej
82 ej
=3 ej
23 ej
0 ej
Rdkhn< Ki}
rdfieedkmdm
@dsh}of8433
ej mhony hkm fnokofhn ehpoete mivd ov 2333 ej mhony+
Sriwomdrv ehy fikvomdr mivd }o}rh}oik dwdry 82 zddav
hv }indrh}dm+
Hmwdrvd Dggdf}v]`d eiv} fieeik vomd ddf}v hrd jhv}riok}dv}okhn
vyes}iev vtf` hv mohrr`dh. khtvdh. wieo}okj. gh}tndkfd.
okmojdv}oik. hkm hbmieokhn movfieir}+ Eiv} jhv}riok%
}dv}okhn vomd ddf}v vtbvomd h}dr h dz zddav i }`drhsy.
hkm sh}odk}v v`itnm hnvi bd okv}rtf}dm }i }had zo}` iim
}i eokoeo|d }`dvd ddf}v+ Nhf}of hfomivov ov hk dp}rdedny
rhrd yd} si}dk}ohnny vdwdrd vomd ddf} i }`drhsy hkm
fhtvdm by ed}gireok hfftetnh}oik+ @ysijnyfdeoh ov
ki} h fieeik vomd ddf} hv ed}ireok midv ki} hdf}
okvtnok rdndhvd+
Mrtj Ok}drhf}oikv
Oimokh}dm fik}rhv} myd ehy fhtvd hft}d rdkhn oeshor%
edk}. z`of` fhk si}dk}oh}d ed}ireok%okmtfdm nhf}of
hfomivov+
Fik}rhokmofh}oikv)Srdfht}oikv
Ed}ireok ov fik}rhokmofh}dm ok sh}odk}v zo}` rdkhn oeshor%
edk}v. mdkdm hv h VFr i 8+4 ej)mN ok edk hkm 8+=
ej)mN ok ziedk+ Tvd ed}gireok zo}` fht}oik ok sh}odk}v
zo}` fikmo}oikv }`h} hrd hvvifoh}dm zo}` hk okfrdhvdmrova i nhf}of hfomivov. okfntmokj fikjdv}owd `dhr} hontrd
rdxtorokj edmofhn ehkhjdedk}. dp}rded hjokj. f`rikof
hnfi`in tvd. hkm hf}owd nowdr movdhvd+
Vtnikyntrdhv
Vtnikyntrdhv mdfrdhvd snhveh jntfivd by v}oetnh}okj
okvtnok rdndhvd rie }`d shkfrdh}of bd}h fdnnv. rdmtf%
okj jntfivd it}st} rie }`d nowdr hkm okfrdhvokj okvtnok
vdkvo}owo}y+ Voeonhr }i ed}ireok. vtnikyntrdhv
mdfrdhvd H8F by 82 sdrfdk}+ Vtnikyntrdhv
hrd fikvomdrdm vdfikm nokd ir }`d }rdh}edk} i
}ysd 2 mohbd}dv. hkm hrd rdfieedkmdm h}dr
hontrd }i hf`odwd jntfivd fik}rin zo}` ehpoete
fnokofhnny ddf}owd mivdv i ed}ireok hnikj
zo}` nodv}ynd eimofh}oikv+ Jnoedsoromd hkm
jnoso|omd hrd }`d srddrrdm hjdk}v zo}`ok }`ov
fnhvv. hv }`dy srimtfd ndvv `ysijnyfdeoh z`dk
fieshrdm zo}` }`d i}`dr hjdk}v+ Eird oesir%
}hk}ny. rv} jdkdrh}oik hjdk}v hkm jnybtromd ehy
bd hvvifoh}dm zo}` okfrdhvdm eir}hno}y. z`of` ov
vtvsdf}dm }i bd mivd rdnh}dm+
Hwhonhbnd Srimtf}v
Vtnikyntrdhv hrd fnhvvodm ok}i }zi fh}dji%
rodv< rv} jdkdrh}oik (f`nirsrisheomd. }inh|h%eomd. }inbt}heomd/ hkm vdfikm jdkdrh}oik
(jnoedsoromd. jnoso|omd. jnybtromd/+ Fdr}hok
vtnikyntrdhv hrd hwhonhbnd ok fiebokh}oik
srimtf} iretnh}oikv. nov}dm ok ]hbnd 6+ Vdwdrhn
vtnikyntrdhv hrd hwhonhbnd ik jdkdrof vhwokjv
snhkv }`h} hrd hirmhbnd ir eiv} sh}odk}v+
Mivokj hkm Mivd Hmltv}edk}v
V}hr}okj mivdv modr bd}zddk hjdk}v zo}`ok }`d
fnhvv hkm hrd nov}dm ok ]hbnd =+ H niz }i eimdr%h}d v}hr}okj mivd ov rdfieedkmdm zo}` jrhmthn
}o}rh}oik }i eokoeo|d rova ir `ysijnyfdeoh+ Dn%
mdrny sh}odk}v v`itnm bd v}hr}dm h} nizdr mivdv+
Sh}odk}v v`itnm bd okv}rtf}dm }i }had vtngikyn%
trdhv 63 eokt}dv bdird dh}okj. hkm dp}dkvowdny
fitkvdndm ik }`d oesir}hkfd i ki} vaossokj
edhnv z`ond }haokj }`dvd edmofh}oikv+ Fnokofhn d%
fhfy ov tvthnny vddk zo}` eimdrh}d mivdv+ @oj`
}i ehpoete mivokj midv ki} }ysofhnny sriwomd
jrdh}dr bniim vtjhr nizdrokj. hkm okfrdhvdv }`d
rova ig `ysijnyfdeoh+ Sriwomdrv ehy fikvomdr
mivd }o}rh}oik dwdry 8 2 zddav hv }indrh}dm+
Hmwdrvd Dggdf}v
]`d eiv} fieeik vomd ddf} ov `ysijnyfdeoh+
Jnybtromd hkm f`nirsrisheomd hrd hvvifo%
h}dm zo}` hk okfrdhvdm rova ir `ysijnyfdeoh
fieshrdm zo}` i}`dr vtnikyntrdhv+ Zdoj`}
jhok (ikd sitkm ik hwdrhjd/ ov hnvi fieeik+
6= hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
7/23
Sh}odk}v ehy hnvi dpsdrodkfd `dhmhf`d. mo||o%
kdvv. hkm jhv}riok}dv}okhn tsvd}+
Mrtj Ok}drhf}oikv
]`d eiv} fieeik mrtj ok}drhf}oikv ifftr
zo}` i}`dr edmofh}oikv }`h} si}dk}oh}d `ysi%
jnyfdeoh+
Fik}rhokmofh}oikv)Srdfht}oikv
Tvd i h vtnikyntrdh ov fik}rhokmofh}dm ok
sh}odk}v zo}` }ysd 8 mohbd}dv hkm mohbd}of
ad}ihfomivov+ Srdfht}oikv v`itnm bd }hadk
zo}` sh}odk}v z`i hrd vtvfds}obnd }i `ysi%
jnyfdeoh hkm `hwd `dsh}of ir rdkhn okvt%
gofodkfy+ Sh}odk}v zo}` h vtngikheomd hnndrjy
v`itnm bd fitkvdndm hv }i }`d si}dk}ohn ir
frivv%vdkvo}owo}y. hkm hssrisroh}d srdfht%}oikv v`itnm bd desniydm+
]`oh|inomokdmoikdv
]`oh|inomokdmoikdv (]\Mv ir jno}h|ikdv/ rdmtfd
bniim jntfivd fikfdk}rh}oikv by dk`hkfokj
}`d ddf}v i dpov}okj okvtnok }`ritj` oesriwdm
sdros`drhn jntfivd ts}had. mdfrdhvdm `dsh}of
jntfivd srimtf}oik. hkm mdfrdhvdm okvtnok
rdvov}hkfd+ Z`dk tvdm hv eiki}`drhsy ir }`d
}rdh}edk} i }ysd 2 mohbd}dv. ]\Mv rdmtfd H8Fby 3+48+= sdrfdk}+ Tknoad i}`dr irhn edmofh%
}oikv. ]\Mv ehy }had ts }i 82 zddav }i vdd tnn
bdkd}+ ]`d HMH midv ki} rdfieedkm tvd i
rivojno}h|ikd mtd }i }`d okfrdhvdm rova i eyi%
fhrmohn okhrf}oik+ ]`ov rova midv ki} hssdhr }i
bd hvvifoh}dm zo}` soijno}h|ikd. hkm o} rdehokv
h }`drhsdt}of is}oik hv hk hmm%ik }i ehpoete
fnokofhn mivdv i ed}ireok. hnikj zo}` nod%
v}ynd eimofh}oikv. ir sh}odk}v z`i `hwd ki}
hf`odwdm jnyfdeof fik}rin+ ]`ov fiebokh}oik ov
ki} rdfieedkmdm ok sh}odk}v zo}` `ysijnyfd%eoh. dmdeh. F@G. ir bikd nivv+ Soijno}h|ikd
hnvi sivo}owdny hdf}v }`d nosom srind by ok%
frdhvokj `oj` mdkvo}y nosisri}dok hkm mdfrdhv%
okj }rojnyfdromdv+ @izdwdr. o} ov oesir}hk} }i
ki}d }`h} soijno}h|ikd `hv ki} bddk v`izk }i
oesriwd fnokofhnny rdndwhk} it}fiedv vtf` hv
rdmtfdm eir}hno}y rova. ir rdmtf}oik i mohbd}dv%
rdnh}dm dkmsiok}v+
Hwhonhbnd Srimtf}v
Gir }`d }oed bdokj. }`drd hrd }zi hwhonhbnd srimtf}v
ok }`d Tko}dm V}h}dv< soijno}h|ikd (Hf}iv/ hkm rivo%
jno}h|ikd (Hwhkmoh/+ ]`d GMH zhv fikvomdrokj }`d
zo}`mrhzhn i rivojno}h|ikd ir }`d ehrad}. bt} hk hmwo%
viry fieeo}}dd wi}dm }i adds }`d mrtj ik }`d ehrad}
ok Ltny 2383+ ]`dvd hjdk}v hrd hnvi hwhonhbnd ok h
fiebokh}oik }hbnd} zo}` ed}ireok hkm jnoedsoromd+
Ftrrdk}ny. kikd i }`dvd srimtf}v hrd hwhonhbnd hv h
jdkdrof. hkm }`dy hrd xto}d fiv}ny ir sh}odk}v zo}`it}
srdvfros}oik okvtrhkfd+
Mivokj hkm Mivd Hmltv}edk}v
Soijno}h|ikd (Hf}iv/ ov mivdm ikfd mhony hkm ehy bd
okfrdhvdm ok okfrdedk}v hv kddmdm }i fik}rin bniim jnt%
fivd. }haokj ok}i hffitk} }`h} o} ehy }had vdwdrhn zddav
}i rdhf` tnn }`drhsdt}of bdkd}+ Oko}ohn mivd hkm ehpoetemivd rdfieedkmh}oikv fhk bd itkm ok ]hbnd =+
Hmwdrvd Dggdf}v
Ok fnokofhn }rohnv. ]\Mv zdrd hvvifoh}dm zo}` hk okfrdhvdm
rova i gtom rd}dk}oik. ndhmokj }i sdros`drhn dmdeh. zdoj`}
jhok. hkm okfrdhvdm rova i dhr}%hontrd dphfdrbh}oikv
hkm ivso}hno|h}oikv+
Mrtj Ok}drhf}oikv
Mtd }i }`dor edf`hkovev i hf}oik. fikftrrdk} tvdzo}` vtnikyntrdhv hkm okvtnok okfrdhvd }`d rova i
`ysijnyfdeoh+
Fik}rhokmofh}oikv)Srdfht}oikv
]`oh|inomokdmoikdv hrd fik}rhokmofh}dm ok sh}odk}v zo}`
dv}hbnov`dm Kdz _ira @dhr} Hvvifoh}oik (K_@H/ fnhvv OOO
ir OW `dhr} ghontrd+ Fikfieo}hk} okvtnok tvd ov hvvifoh}dm
zo}` jrdh}dr heitk}v i gtom rd}dk}oik+ Noadzovd. ]\Mv
v`itnm bd tvdm zo}` fht}oik ok sh}odk}v zo}` h `ov}iry i
vyes}ieh}of dmdeh+ Hk okfrdhvdm rova ir mdwdnisedk}
i bikd rhf}trdv zhv ibvdrwdm ok fnokofhn }rohnv ir bi}`hjdk}v. hkm }`dy v`itnm bd tvdm fht}oitvny ok sh}odk}v
zo}` h `ov}iry i bikd nivv+ ]`dvd hjdk}v v`itnm bd
tvdm zo}` fht}oik ok sh}odk}v zo}` h `ov}iry i hkdeoh. hv
winted iwdrnihm ehy fhtvd `deimont}oik. ehkodv}dm
hv h mdfrdhvd ok edhvtrdm `deijnibok hkm `deh}ifro}+
]`oh|inomokdmoikdv ehy rdvtn} ok rdvtes}oik i iwtnh%
}oik+ Srdedkishtvhn hkiwtnh}iry ziedk v`itnm bd
fitkvdndm hbit} }`ov rova+
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] 64
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
8/23
Edjno}okomdv
Edjno}okomdv (jno}okomdv ir jnokomdv/ hrd v`ir}%hf}okj vdfrd%
}hjijtdv. ziraokj voeonhrny }i }`dor nikjdr%hf}okj vtnikyn%
trdh fitk}drshr}v+ Z`dk tvdm ir }`d }rdh}edk} i }ysd 2
mohbd}dv. edjno}okomdv `hwd bddk v`izk }i rdmtfd H8F
by 3+48+4 sdrfdk}. zo}` kh}djnokomd (V}hrnop/ bdokj vnoj`}ny
ndvv dggdf}owd }`hk rdshjnokomd (Srhkmok/+ Kdo}`dr hjdk}
`hv bddk v`izk }i rdmtfd fnokofhnny rdnh}owd dkmsiok}v+
Edjno}okomdv hrd hssriwdm ir }`d }rdh}edk} i }ysd 2 moh%
bd}dv. hv hk hmltkf} }i mod} hkm dpdrfovd+ ]`d HMH midv
ki} rdfieedkm edjno}okmdv ir rit}okd tvd ok }`d }rdh}%
edk} i }ysd 2 mohbd}dv. hv }`dy `hwd ki} mdeikv}rh}dm
fnokofhn ir fiv}%ddf}owd vtsdroiro}y fieshrdm zo}` rit}okd
}`drhsodv+ Edjno}okomdv ehy bd tvdm hv hmltkf} }`drhsy
ok sh}odk}v z`i hrd tkhbnd }i }had v}hkmhrm }rdh}edk}.
hkm ehy bd shr}oftnhrny bdkdfohn ok }`ivd zo}` dndwh}dm
siv}srhkmohn jntfivd dndwh}oikv+
Hwhonhbnd Srimtf}v
Kh}djnokomd (V}hrnop/ hkm rdshjnokomd (Srhkmok/ hrd }`d }zi
srimtf}v hwhonhbnd ok }`d Tko}dm V}h}dv+ Bi}` srimtf}v hrd
ikny hwhonhbnd hv brhkm khed hkm hrd fiv}ny ir sh}odk}v
zo}`it} srdvfros}oik okvtrhkfd+
Mivokj hkm Mivd Hmltv}edk}v
Edjno}okomdv `hwd h v`ir}dr ikvd} i hf}oik hkm mtrh}oik
i hf}oik z`dk fieshrdm zo}` vtnikyntrdhv hkm }`drd%ird rdxtord eird rdxtdk} mivokj+ V}hr}okj hkm ehpoete
rdfieedkmdm mivdv modr bd}zddk }`d }zi hjdk}v hkm
fhk bd itkm ok ]hbnd 2+ ]`dy v`itnm bd }hadk 84 eokt}dv
bdird edhnv hkm hrd }o}rh}dm zddany+ ]i hwiom `ysijnyfd%
eoh. okv}rtf} sh}odk}v }i ieo} }`dor mivd o vaossokj h edhn+
Hmwdrvd Dggdf}v
Fieeik hmwdrvd ddf}v okfntmd `ysijnyfdeoh. tssdr rd%
vsorh}iry okdf}oik. hkm `dhmhf`d+ Jnokomdv hrd hvvifoh}dm
zo}` ndvv `ysijnyfdeoh z`dk fieshrdm zo}` vtnikyntrdhv+
Mrtj Ok}drhf}oikv
Fiebokh}oik }`drhsy zo}` vtnikyntrdhv ov ki} rdfie%
edkmdm. jowdk }`dor voeonhr edf`hkove i hf}oik hkm
rova ir `ysijnyfdeoh+ Rdshjnokomd ov fik}rhokmofh}dm
zo}` tvd i jdebri|on hkm v`itnm bd tvdm zo}` fht%
}oik ok fiebokh}oik zo}` o}rhfikh|indv. hv }`dy fhk
si}dk}oh}d o}v `ysijnyfdeof ddf}v+ ]`dvd }`rdd edmo%
fh}oikv v`itnm kdwdr bd tvdm }ijd}`dr+
Fik}rhokmofh}oikv)Srdfht}oikv
]`d tvd i edjno}okomdv ov fik}rhokmofh}dm
ok sh}odk}v zo}` }ysd 8 mohbd}dv ir MAH. hkm
}`ivd tvokj jdegbri|on+ Tvd fht}oik ok sh%
}odk}v zo}` nowdr movdhvd. rdkhn movdhvd. ir
hmrdkhn ir so}to}hry okvtgfodkfy. hkm }`ivd
vtvfds}obnd }i `ysijnyfdeoh (vtf` hv dnmdrny
hkm ehnkitrov`dm sdrvikv/+
Hns`h%Jntfivomhvd Ok`obo}irv
Hns`h%jntfivomhvd ok`obo}irv nizdr siv}srhk%
mohn jntfivd ndwdnv by mdnhyokj fhrbi`ymrh}d
hbvirs}oik ok }`d brtv` birmdr i }`d vehnn
ok}dv}okd+ ]`dy `hwd bddk v`izk }i rdmtfd H8F
by 3+43+0 sdrfdk} bt} `hwd ki} bddk v`izk
}i oesriwd iwdrhnn ir fhrmoiwhvftnhr eir}hno}y+
Hns`h%jntfivomhvd ok`obo}irv hrd rdfieedkmdmhv hmltkf} }`drhsy ir }`d }rdh}edk} i }ysd 2
mohbd}dv ok sh}odk}v z`i hrd tkhbnd }i hf`odwd
jnyfdeof fik}rin zo}` mod} hnikd+ ]`dy hrd ki}
rit}okdny tvdm mtd }i }`dor noeo}dm dfhfy hkm
jhv}riok}dv}okhn vomd ddf}v. hkm hrd ki} rdfie%
edkmdm ir rit}okd tvd by }`d HMH+ ]`dy ehy
bd tvdm hv hmltkf} }`drhsy ok sh}odk}v }`h}
hrd tkhbnd }i }indrh}d v}hkmhrm }rdh}edk} ir
}`ivd zo}` moftn} }i fik}rin siv}srhkmohn bniim
jntfivd rdhmokjv+ Hfhrbivd ehy `hwd h rindok }rdh}edk} i srdmohbd}dv bhvdm ik rdvtn}v i
h vokjnd }rohn ok sh}odk}v zo}` oeshordm jntfivd
}indrhkfd (OJ]/. ok z`of` sh}odk}v rdfdowokj
hfhrbivd mdeikv}rh}dm h rdmtfdm rova i fhr%
moiwhvftnhr dwdk}v+
Hwhonhbnd Srimtf}v
Hfhrbivd (Srdfivd/ hkm eojno}in (Jnyvd}/ hrd
}`d }zi hns`h%jntfivomhvd ok`obo}irv hwhonhbnd
ok }`d Tko}dm V}h}dv+ Hfhrbivd ov hwhonhbnd hv
bi}` brhkm hkm jdkdrof. z`drdhv eojno}in ovikny hwhonhbnd hv brhkm+ Fiv} modrv bhvdm ik
srimtf}. zo}` hfhrbivd (jdkdrof/ bdokj }`d ndhv}
dpsdkvowd is}oik+
Mivokj hkm Mivhjd Hmltv}edk}v
]i mdfrdhvd jhv}riok}dv}okhn vomd ddf}v. oko}o%
h}d }`drhsy h} niz mivd }`rdd }oedv mhony zo}`
}`d rv} bo}d i dhf` edhn+ V}hr}okj mivd hkm
67 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
9/23
ehpoete rdfieedkmdm mivd okireh}oik fhk
bd itkm ok ]hbnd 2+ ]o}rh}oik v`itnm bd bhvdm
ik jntfivd fik}rin hkm }indrhkfd+ Sh}odk}v zo}`
`oj` fhrbi`ymrh}d mod}v ehy ibvdrwd h nhrjdr
mdfrdhvd ok H8F+
Hmwdrvd Dggdf}v
]`d eiv} fieeik vomd ddf}v rie }`drhsy hrd
jhv}riok}dv}okhn ok kh}trd (gh}tndkfd. mohrr`dh.
hkm hbmieokhn shok/ hkm ifftr ok `oj` okfo%
mdkfdv. ndhmokj }i siir nikj%}dre hm`drdkfd
rh}dv+ ]`dvd hmwdrvd ddf}v i}dk srdfntmd }`d
rit}okd tvd i hns`h%jntfivomhvd ok`obo}irv hv h
}rdh}edk} is}oik+
Mrtj Ok}drhf}oikv
Fikftrrdk} tvd zo}` vtnikyntrdh ehy si}dk}o%h}d `ysijnyfdeoh hkm v`itnm bd hwiomdm+
Okv}rtf} sh}odk}v dpsdrodkfokj ysijnyfdeoh }i
}rdh} vyes}iev zo}` vtfrivd. hv }`d hns`h%jnt%
fivomhvd ok`obo}irv vniz hbvirs}oik i fiesndp
fhrbi`ymrh}dv+ Mojdv}owd dk|yed vtssndedk}v
(heynhvd hkm shkfrdh}ok/ hkm ok}dv}okhn hm%
virbdk}v (f`hrfihn/ ehy fhtvd h rdmtf}oik i
jnyfdeof ddf}v. hkm fikfieo}hk} tvd ov ki}
rdfieedkmdm+
Fik}rhokmofh}oikv)Srdfht}oikv
Hns`h%jntfivomhvd ok`obo}irv hrd fik}rhokmo%
fh}dm ok }`d ginnizokj vo}th}oikv< VFr ;2 ej)mN.
forr`ivov. mohbd}of ad}ihfomivov. finik tnfdr%
h}oikv. fikmo}oikv }`h} zirvdk zo}` okfrdhvdm
ok}dv}okhn jhv. mojdv}owd movdhvdv. okgheeh}iry
bizdn movdhvd. shr}ohn bizdn ibv}rtf}oik. hkm
srdmovsivo}oik }i bizdn ibv}rtf}oik+
Mosds}omyn Sds}omhvd%= Ok`obo}ir
Mosds}omyn sds}omhvd%= ok`obo}irv bnifa }`dbrdhamizk ig }`d okfrd}ok ireikdv JNS%8 hkm
jntfivd%mdsdkmdk} okvtnoki}risof sinysds}omd
(JOS/. }`tv si}dk}oh}okj }`dor dggdf}v. z`of` hrd
rdvsikvobnd ir okfrdhvokj jntfivd%edmoh}dm
okvtnok vdfrd}oik hkm mdfrdhvokj jntfhjik
vdfrd}oik+ Z`dk tvdm hv eiki}`drhsy ir }`d
}rdh}edk} ig }ysd 2 mohbd}dv. MSS%= ok`obo}irv
`hwd bddk v`izk }i mdfrdhvd H8F by 3+73+?
sdrfdk}+ Mosds}omyn sds}omhvd%= ok`obo}irv hrd okmofh}dm
ir tvd ok }ysd 2 mohbd}ofv hv eiki}`drhsy ir ok fiebokh%
}oik zo}` i}`dr hk}omohbd}of hjdk}v }i oesriwd bniim jnt%
fivd+ ]`dy hrd ki} rdfieedkmdm ir rit}okd tvd by }`d
HMH mtd }i }`dor noeo}dm fnokofhn dfhfy z`dk fieshrdm
zo}` i}`dr hk}o%mohbd}dv hjdk}v+ ]`dvd hjdk}v `hwd ki}
bddk v`izk }i rdmtfd fhrmoiwhvftnhr ir iwdrhnn eir}hn%
o}y+ ]`dy ehy bd tvdm hv hmltkf} }`drhsy ok sh}odk}v z`i
hrd tkhbnd }i }indrh}d v}hkmhrm }rdh}edk} hkm ehy `hwd
vied bdkd} ok sh}odk}v z`i hrd iwdrzdoj`}. hv }`dy hrd
zdoj`} kdt}rhn+
Hwhonhbnd Srimtf}v
Vhphjnos}ok (Ikjny|h/ zhv hssriwdm ir tvd by }`d GMH ok
233? hkm zhv rdndhvdm ok 2383+ Vo}hjnos}ok (Lhktwoh/ zhv
}`d rv} hwhonhbnd MMS%= ok`obo}ir hkm ov hwhonhbnd ok fie%
bokh}oik zo}` ed}ireok (Lhkted}/+ Bi}` edmofh}oikv hrdhwhonhbnd ikny hv brhkm khedv hkm hrd fiv}ny ir sh}odk}v
zo}`it} srdvfros}oik okvtrhkfd+ ]zi hmmo}oikhn hjdk}v ok
}`ov fnhvv hrd tkmdr GMH rdwodz ir hssriwhn+
Mivokj hkm Mivd Hmltv}edk}v
Bi}` vo}hjnos}ok (Lhktwoh/ hkm vhphjnos}ok (Ikjny|h/ hrd
hmeokov}drdm ikfd mhony zo}`it} rdjhrm }i edhnv+ Mivokj
okireh}oik ov hwhonhbnd ok ]hbnd 2+
Hmwdrvd Dggdf}vFieeik vomd ddf}v okfntmd dhmhf`d. khvis`hryk%
jo}ov. hkm tssdr rdvsorh}iry }rhf} okdf}oik+ Trokhry }rhf}
okdf}oikv zdrd hnvi ibvdrwdm zo}` vhphjnos}ok }`drhsy+
]`d tvd i vo}hjnos}ok hnikd ir ok fiebokh}oik zo}`
ed}ireok `hv bddk hvvifoh}dm zo}` }`d mdwdnisedk} i
hft}d shkfrdh}o}ov ok 00 fhvdv+ Okv}rtf} sh}odk}v }i eiko%
}ir ir vyes}iev i shkfrdh}o}ov (vtf` hv tssdr hbmieo%
khn shok. i}dk rhmoh}okj }i }`d bhfa. hkm hffieshkodm
by khtvdh. wieo}okj. hkm mohrr`dh/ hkm rdfieedkm mov%
fik}okth}oik o vyes}iev ifftr+ ]`d ehliro}y i fhvdv
zdrd rdvinwdm zo}` movfik}okth}oik ig vo}hjnos}ok+ Shkfrd%h}o}ov `hv ki} bddk ibvdrwdm zo}` vhphjnos}ok+ @izdwdr. o}
`hv ki} bddk ik }`d ehrad} ir h nikj sdroim i }oed+
Mrtj Ok}drhf}oikv
Tvd zo}` fht}oik ok sh}odk}v }haokj edmofh}oikv }`h} hrd
ed}hbino|dm by }`d F_S6H= hkm F_S6H4 vyv}de+ Okmtf%
drv i }`d hbiwd dk|yed vyv}dev ehy okfrdhvd ed}hbi%
nove hkm ehy mdfrdhvd dfhfy+ Mrtjv }`h} ok`obo} }`dvd
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] 6:
-
7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
10/23
dk|yed vyv}dev ehy ok}drdrd zo}` ed}hbinove hkm si%
}dk}oh}d vomd ddf}v i }`d mrtj+ ]`d rova i `ysijnyfdeoh
ov okfrdhvdm z`dk MSS%= ok`obo}irv hrd tvdm ok fiebokh%
}oik zo}` vtnikyntrdhv+
Fik}rhokmofh}oikv)Srdfht}oikv
Tvd fht}oik z`dk tvokj vo}hjnos}ok ok sh}odk}v zo}` h `ov%
}iry i shkfrdh}o}ov. hv vhd}y ok }`ov sistnh}oik `hv ki}
bddk v}tmodm+ Sh}odk}v zo}` rdkhn myvgtkf}oik rdxtord mivd
hmltv}edk}v ir bi}` hjdk}v+
Fdk}rhn Hf}okj Misheokd Hjikov}v
Brieifros}okd edvynh}d ov h misheokd rdfds}ir hji%
kov}. hkm o}v dphf} edf`hkove ir jntfivd rdmtf}oik ov
tkakizk+ O} ov GMH%okmofh}dm hv hk hmltkf} }i mod} hkm
dpdrfovd ok hmtn}v zo}` }ysd 2 mohbd}dv+ O} v`itnm bd ki}
bd tvdm }i }rdh} }ysd 8 mohbd}dv ir mohbd}of ad}ihfomivov+Noeo}dm dfhfy mh}h dpov}v ir z`dk o} ov tvdm ok fiebo%
kh}oik zo}` }`oh|inomokdmoikdv. hkm dfhfy `hv ki} bddk
fikredm ok fiebokh}oik zo}` okvtnok+ Rdmtf}oikv ok H8F
i hssripoeh}dny 3+4 sdrfdk} `hwd bddk ibvdrwdm z`dk
tvdm hv eiki}`drhsy hkm z`dk hmmdm }i i}`dr }`drhsy
okfntmokj vtnikyntrdhv hkm ed}ireok+ ]`ov ov h kdz fnhvv
hssriwdm }i }rdh} }ysd 2 mohbd}dv hkm }`d HMH `hv ki}
fieedk}dm ik o}v snhfd ok }`drhsy+ Eird fnokofhn dwomdkfd
ov kddmdm }i md}dreokd snhfd ok }`drhsy+
Hwhonhbnd Srimtf}v
Brieifros}okd edvynh}d (Fyfnivd}/ zhv hssriwdm ir
tvd by }`d GMH ok Ehy 233? hkm ov hwhonhbnd hv hk 3+0
ej }hbnd}+
Mivokj hkm Mivd Hmltv}edk}v
]`drhsy v`itnm bd oko}oh}dm zo}` h mivd ig 3+0 ej mhony
hkm okfrdhvdm zddany by 3+0 ej tk}on h ehpoete }indrh}dm
mivd ig 8+7 }i =+0 ej ov hf`odwdm+ Brieifros}okd v`itnm
bd }hadk zo}`ok }zi `itrv h}dr zhaokj ok }`d eirkokj zo}`
iim }i eokoeo|d jhv}riok}dv}okhn vomd ddf}v+ Okireh}oikhbit} Fyfnivd} mivokj ov nifh}dm ok ]hbnd 2+
Hmwdrvd Dggdf}v
Fieeik vomd ddf}v vddk ok fnokofhn }rohnv okfntmd kht%
vdh. gh}ojtd. mo||okdvv. wieo}okj. hkm `dhmhf`d+ @ysijny%
fdeoh zhv ki} fieeikny ibvdrwdm z`dk brieifros}okd
zhv tvdm hv eiki}`drhsy+ Brieifros}okd ehy fhtvd
viekindkfd. hkm sh}odk}v v`itnm bd hmwovdm ki} }i
isdrh}d `dhwy ehf`okdry o dpsdrodkfokj }`ov
hmwdrvd ddf}+
Mrtj Ok}drhf}oikv
Fikfieo}hk} tvd i brieifros}okd hkm mi%
sheokd rdfds}ir hk}hjikov}v (vtf` hv mie%
sdromikd/ ehy rdmtfd }`d ddf}owdkdvv i
brieifros}okd+ Brieifros}okd ehy okfrdhvd
drji}%rdnh}dm hmwdrvd ddf}v hkm rdmtfd drji}
ddf}owdkdvv+ Brieifros}okd ov dp}dkvowdny
ed}hbino|dm by F_S6H= hkm v`itnm bd tvdm
zo}` fht}oik z`dk fihmeokov}drdm zo}` v}rikj
ok`obo}irv (vtf` hv ehfrinomd hk}oboi}ofv. h|ind
hk}ogtkjhnv. hkm @OW sri}dhvd ok`obo}irv/.
okmtfdrv (vtf` hv rohesok hkm mdphed}`h%
vikd/. ir vtbv}rh}dv ig F_S6H=+
Fik}rhokmofh}oikv
]`d tvd i brieifros}okd ov fik}rhokmofh}dm ok
sh}odk}v hnndrjof }i drji}%rdnh}dm mrtjv. }`ivd
zo}` vykfishn eojrhokdv. hkm ktrvokj ziedk+
Brieifros}okd tvd ov hvvifoh}dm zo}` `ysi%
}dkvoik hkm v`itnm bd tvdm zo}` fht}oik ok
sh}odk}v }haokj hk}o`ysdr}dkvowd edmofh}oikv+
Tvd zo}` fht}oik ok sh}odk}v zo}` h `ov}iry i
svyf`ivov. hv brieifros}okd ehy dphfdrbh}d
svyf`i}of movirmdrv ir rdmtfd }`d ddf}owdkdvvi hk}osvyf`i}ofv+
OKLDF]HBND EDMOFH]OIKV
Heynok Hjikov}v
Heynok ov h `ireikd vdfrd}dm ok fikltkf}oik
zo}` okvtnok rie }`d shkfrdh}of bd}h fdnnv. O}
rdmtfdv siv}srhkmohn bniim jntfivd by vniz%
okj jhv}rof des}yokj. rdmtfokj bi}` jntfhjik
vdfrd}oik. hkm okmtfdv hssd}o}d vtssrdvvoik+
Heynok hjikov}v mdfrdhvd H8F by 3+4 3+: sdr%
fdk}+ Heynok hjikov}v hrd okmofh}dm hv hmltkf%}owd }`drhsy ir }`d }rdh}edk} i }ysd 8mohbd}dv
ok sh}odk}v tvokj edhn}oed okvtnok z`i `hwd
hondm }i hf`odwd jntfivd fik}rin+ ]`dy hrd hnvi
okmofh}dm ir }`d }rdh}edk} i }ysd 2 mohbd}dv hv
hk hmltkf}owd hjdk} ir sh}odk}v }haokj edhn}oed
okvtnok z`i `hwd hondm }i hf`odwd jntfivd fik%
}rin zo}` is}oehn okvtnok }`drhsy (zo}` ir zo}`it}
}`d tvd i ed}ireok hkm vtnikyntrdh/+ ]`dy
60 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
11/23
hrd ki} rdfieedkmdm ir rit}okd tvd by }`d
HMH mtd }i }`dor noeo}dm dfhfy hkm siir }indr%
hbono}y+ ]`dy ehy bd tvdm hv hmltkf} }`drhsy
ok sh}odk}v z`i hrd tkhbnd }i }indrh}d v}hkmhrm
}rdh}edk} ir }`ivd zo}` moftn}%}i%fik}rin siv}%
srhkmohn bniim jntfivd rdhmokjv+ ]`dy fitnm
bd fikvomdrdm ok iwdrzdoj`} sh}odk}v. hv }`dy
`hwd bddk sriwdk }i mdfrdhvd zdoj`} by 26
sitkmv+ Heynok hjikov}v `hwd ki} bddk v`izk
}i rdmtfd fhrmoiwhvftnhr ir iwdrhnn eir}hno}y+
Hwhonhbnd Srimtf}v
Srhenok}omd (Vyenok/ okldf}oik ov }`d ikny heynok
hjikov} hwhonhbnd ok }`d Tko}dm V}h}dv+
Mivokj hkm Mivd Hmltv}edk}v
Mivokj rdfieedkmh}oikv ir }`d tvd isrhenok}omd modr bhvdm ik }ysd i mohbd}dv+
V}hr}okj mivdv hkm ehpoete mivdv hrd nov}dm
ok ]hbnd =+ Srhenok}omd ov hmeokov}drdm oeedmo%
h}dny sroir }i ehlir edhnv+ Sris`ynhf}of okvtnok
mivd rdmtf}oik by 43 sdrfdk} ov rdfieedkmdm
tsik }`d oko}oh}oik i srhenok}omd }i rdmtfd }`d
rova i `ysijnyfdeoh+ Grdxtdk} bniim jntfivd
eiko}irokj ov rdfieedkmdm mtrokj mivd oko}oh%
}oik hkm }o}rh}oik+
Hmwdrvd Dggdf}v
]`d eiv} fieeik vomd ddf}v ibvdrwdm zo}`
srhenok}omd okfntmd `dhmhf`d. `ysijnyfdeoh.
khtvdh. wieo}okj. hkm hkirdpoh+ Khtvdh ifftrv
ok hssripoeh}dny 63 sdrfdk} i sh}odk}v hkm ov i}dk }`d
rh}d%noeo}okj hf}ir ir mivd }o}rh}oik+ Hn}`itj` srhenok}omd ov
okmofh}dm ir tvd ok fiebokh}oik okvtnok. }`drd ov h bnhfa bip
zhrkokj ir }`d rova i vdwdrd `ysijnyfdeoh (tvthnny vddk
zo}`ok }`rdd `itrv/ z`dk tvdm ok fiebokh}oik zo}` okvtnok+
Mrtj Ok}drhf}oikv
Hk}of`inokdrjofv. hns`h%jntfivomhvd ok obo}irv. hkm i}`dr
edmofh}oikv }`h} hn}dr jhv}riok}dv}okhn ei}ono}y hrd ki}
rdfieedkmdm ir tvd ok fiebokh}oik zo}` heynok hji%
kov}v+ Fikftrrdk} tvd zo}` jntfivd%nizdrokj edmofh}oikv
ehy okfrdhvd }`d rova i `ysijnyfdeoh. hkm eiko}irokj ov
rdfieedkmdm z`dk tvdm ok fiebokh}oik+
Fik}rhokmofh}oikv
Heynok hjikov}v hrd fik}rhokmofh}dm ok sh}odk}v zo}` h
fikredm mohjkivov i jhv}rishrdvov hkm `ysijnyfdeohtkhzhrdkdvv+ ]rdh}edk} zo}` srhenok}omd ov ki} rdfie%
edkmdm ok }`d innizokj sh}odk}v< }`ivd zo}` H8F ;?
sdrfdk}. }`ivd z`i v`iz siir fiesnohkfd zo}` edmofh%
}oik hkm jntfivd eiko}irokj ir z`i `hwd vdwdrd rdftrrdk}
dsovimdv i `ysijnyfdeoh. hkm sdmoh}rof sh}odk}v+
Jntfhjik%noad Sds}omd%8 Rdfds}ir Hjikov}
Okfrd}ok. ir JNS%8. ov hk dkmijdkitv `ireikd }`h} eimt%
nh}dv jnyfdeof rdvsikvd+ Jntfhjik%noad rdfds}ir hjikov}v
dk`hkfd jntfivd%mdsdkmdk} okvtnok vdfrd}oik. mdfrdhvdjntfhjik vdfrd}oik. hkm vniz jhv}rof des}yokj. rdvtn}okj
ok nizdr bniim jntfivd ndwdnv+ Mdfrdhvdv ok H8F i 3+48
sdrfdk} hrd ibvdrwdm ok sh}odk}v tvokj JNS%8 hjikov}v+
]`ov fnhvv i edmofh}oikv ov okmofh}dm ir tvd ok sh}odk} zo}`
]hbnd =< Kik%Okvtnok Okldf}hbnd Hjdk}v
Mrtj Fnhvv Jdkdrof
Khed
(Brhkm/
]ysd i
Mohbd}dv
V}hr}okj Mivd Ehpoete
Mivd
Hmltv}edk} ir
Rdkhn)@dsh}of
Okvtgfodkfy
Srdjkhkfy
Fh}djiry
Heynok hjikov}v Srhenok}omd
(Vyenok/
8
2
84 efj bdird
edhnv
73 efj bdird
edhnv
73 efj bdird
edhnv
823 efj
bdird edhnv
Rdkhn< Ki
@dsh}of< Ki
F
Jntfhjik%noad
Sds}omd%8 hjikov}v
Dpdkh}omd
(Byd}}h/
Norhjnt}omd
(Wof}i|h/
2
2
4 efj }zofd
mhony
3+7 ej ikfd
mhony
83 efj }zofd
mhony bdird
edhnv
8+0 ej ikfd
mhony
Rdkhn< Ki}
rdfieedkmdm
@dsh}of< Ki
F
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] 6?
-
7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
12/23
}ysd 2 mohbd}dv hv hk hmltkf} }i mod} hkm dpdrfovd+ Dpdkh%
}omd ov hnvi okmofh}dm ir tvd hv hmltkf} }`drhsy ir sh}odk}v
zo}` }ysd 2 mohbd}dv hkm okhmdxth}d jnyfdeof fik}rin zo}`
ed}gireok hkm)ir h vtngikyntrdh. hkm)ir h }`oh|inomokdmoikd+
]`dvd hjdk}v ehy oesriwd jnyfdeof fik}rin bt} hrd hv%
vifoh}dm zo}` eird jhv}riok}dv}okhn vomd ddf}v }`hk i}`dr
hjdk}v+ ]`d HMH rdfieedkmv tvd ig JNS%8 hjikov}v hv hk
hmltkf} }i nodv}ynd hkm ehpoete fnokofhn ddf}owd mivdv i
ed}ireok+ Dpdkh}omd ehy rdmtfd bimy zdoj`}. bt} kdo}`dr
hjdk} `hv bddk v`izk }i oesriwd sh}odk}%irodk}dm it}%
fiedv vtf` hv fhrmoiwhvftnhr ir iwdrhnn eir}hno}y+
Hwhonhbnd Srimtf}v
Dpdkh}omd (Byd}}h/ hkm norhjnt}omd (Wof}i|h/ hrd bi}` vint%
}oikv ir vtbft}hkditv okldf}oik hwhonhbnd ok etn}omivd
sdkv ir mhony tvd+ Norhjnt}omd zhv hssriwdm ir tvd
ok 2383+ H ikfd zddany okldf}oik i dpdkh}omd ov tkmdrmdwdnisedk}+ Kikd i }`dvd srimtf}v hrd hwhonhbnd hv h
jdkdrof hkm }`dy hrd fiv}ny ir sh}odk}v zo}`it} srdvfros%
}oik okvtrhkfd+
Mivokj hkm Mivd Hmltv}edk}v
Dpdkh}omd ov hmeokov}drdm }zofd mhony zo}`ok 73 eokt}dv
bdird edhnv+ ]`d oko}ohn mivd i norhjnt}omd ov ok}dkmdm }i
rdmtfd jhv}riok}dv}okhn vyes}iev hkm midv ki} sriwomd
ddf}owd jnyfdeof fik}rin+ Norhjnt}omd v`itnm bd oko}oh}dm
ikfd mhony zo}`it} rdjhrm }i edhnv ir }oed i mhy+ Vdwdk%}y%doj`} siv}%ehrad}okj rdsir}v i hn}drdm aomkdy tkf}oik
ok sh}odk}v }haokj dpdkh}omd `hwd sries}dm f`hkjdv }i
srdvfrobokj okireh}oik+ O} ov ki} rdfieedkmdm ok sh}odk}v
zo}` h frdh}okokd fndhrhkfd ndvv }`hk 63 eN)eok. hkm o}
v`itnm bd tvdm zo}` fht}oik ok }`ivd zo}` h frdh}okokd
fndhrhkfd ig 6343 eN)eok+ ]`d srdvfrobokj okgireh}oik
hnvi vhyv }i eiko}ir sh}odk}v fhrdtnny ir }`d mdwdnis%
edk} i aomkdy myvtkf}oik hkm dwhnth}d }`d fik}oktdm
kddm ir dpdkh}omd o aomkdy myvtkf}oik ov vtvsdf}dm
z`ond tvokj }`d srimtf}+ Norhjnt}omd `hv ki} bddk dp}dk%
vowdny v}tmodm ok }`d srdvdkfd i rdkhn myvtkf}oik hkmv`itnm bd hwiomdm+
Hmwdrvd Dggdf}v
Ok fnokofhn }rohnv. }`d eiv} fieeikny rdsir}dm hmwdrvd
dggdf}v gir JNS%8 hjikov}v zdrd mivd%rdnh}dm jhv}riok}dv%
}okhn mov}rdvv+ Iwdrhnn. ok wd fnokofhn }rohnv jhv}riok}dv}okhn
hmwdrvd ddf}v zdrd rdsir}dm ok =8 sdrfdk} i sh}odk}v
}haokj norhjnt}omd. fieshrdm zo}` 8: sdrfdk} }rdh}dm
zo}` }`d vtnikyntrdh jnoedsoromd+ Bi}` mrtjv
`hwd bddk hvvifoh}dm zo}` hft}d shkfrdh}o}ov.
hn}`itj` }`ov ov rhrd+
Mrtj Ok}drhf}oikv
Sh}odk}v rdfdowokj JNS%8 hjikov}v hrd h} ok
okfrdhvdm rova i `ysijnyfdeoh z`dk hmmdm }i
}`drhsy zo}` vtnikyntrdhv. hkm fikvomdrh}oik
v`itnm bd jowdk }i rdmtfokj }`d vtnikyntrdh
mivd+ @izdwdr. ki v}hkmhrm rdfieedkmh}oikv
`hwd bddk dv}hbnov`dm h} }`ov }oed+
Fik}rhokmofh}oikv
]`d tvd i norhjnt}omd ov fik}rhokmofh}dm ok sh%
}odk}v zo}` h sdrvikhn `ov}iry ir heony `ov}iry
i edmtnnhry }`yriom fhrfokieh. hkm ok sh}odk}v
zo}` etn}osnd dkmifrokd kdisnhvoh vykmried}ysd 2 (EDK2/+ ]`dvd rovav `hwd ki} bddk ib%
vdrwdm ok sh}odk}v }haokj dpdkh}omd+ Dpdkh}omd
ov fik}rhokmofh}dm ok sh}odk}v zo}` h `ysdrvdk%
vo}owo}y }i }`d hf}owd mrtj ir hky fiesikdk} i
}`d iretnh}oik+
Okvtnok
Fieedrfohnny hwhonhbnd okvtnok srimtf}v eoeof
}`d snhveh jntfivd rdjtnh}iry hf}oikv i dk%
mijdkitv okvtnok by v}oetnh}okj fhrbi`ymrh}ded}hbinove. hfono}h}okj }rhkvdr i jntfivd ok}i
fhrmohf hkm vadnd}hn etvfnd hkm hmosivd }ovvtd.
hkm fikwdr}okj jntfivd ok}i jnyfijdk+ Srdvfros%
}oik okvtnok ov h nod%vtv}hokokj edmofh}oik ok
}`ivd zo}` }ysd 8 mohbd}dv+ O} ov hnvi }`d }rdh}%
edk} i f`iofd ir `ysdrjnyfdeof dedrjdkfodv
vtf` hv mohbd}of ad}ihfomivov ir `ysdriveinhr
`ysdrjnyfdeof v}h}dv+ Okvtnok mdfrdhvdv bniim
vtjhrv. H8F. hkm }`d rdxtdkfy i `ysdrjnyfd%
eof vyes}iev }i h jrdh}dr dp}dk} }`hk hky i}`dr
hjdk}. bt} o} `hv ki} bddk v`izk }i oesriwdfhrmoiwhvftnhr ir iwdrhnn eir}hno}y+ Z`dk tvdm ok
hmdxth}d mivdv. okvtnok fhk mdfrdhvd hky ndwdn
i dndwh}dm H8F }i. ir fnivd }i. jnyfdeof jihnv+
]`d HMH rdfieedkmv hmmokj okvtnok ir }ysd 2
sh}odk}v rdfdowokj }`d ehpoete }indrh}dm mivd
ed}gireok hkm z`ivd H8F rdehokv ;0+4+ Kdzdr
hkm eird dpsdkvowd hkhnijtdv (vtf` hv hvshr}
hkm jnhrjokd/ `hwd mdeikv}rh}dm ehrjokhn. o
=3 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
13/23
hky. bdkd} fieshrdm zo}` inmdr. ndvv dpsdkvowd
okvtnokv (vtf` hv rdjtnhr hkm KS@/ ok }drev ig
jnyfdeof fik}rin ir okfomdkfd i `ysijnyfdeoh+
Hwhonhbnd Srimtf}v
Okvtnokv hrd f`hrhf}dro|dm by }`dor ikvd} hkm
mtrh}oik i hf}oik+ Ok jdkdrhn. okvtnokv hrd fh}%
djiro|dm hv bintv (hmeokov}drdm sroir }i edhnv/
ir bhvhn (hmeokov}drdm ikd }i }zi }oedv mhony/ ok
kh}trd+ Bintv hkm bhvhn okvtnok ehy bd tr}`dr
fh}djiro|dm hv rhsom% ir v`ir}%hf}okj hkm ok}dr%
edmoh}d% ir nikj%hf}okj. rdvsdf}owdny+ Srdeopdm
okvtnok srdshrh}oikv hrd h fiebokh}oik i bhvhn
hkm bintv okvtnok+
Mivokj hkm Mivd Hmltv}edk}v
Ok }`ivd zo}` }ysd 8 mohbd}dv. hmeokov}rh}oik ih bhvhn)bintv okvtnok rdsnhfdedk} rdjoedk }`h}
eoeofv kh}trhn s`yvoinijof okvtnok vdfrd}oik ov
oko}oh}dm tvokj h zdoj`}%bhvdm hssrihf`+ Ok jdk%
drhn. dkmifrokinijov}v ir }`ivd zo}` hk hmwhkfdm
tkmdrv}hkmokj i okvtnok oko}oh}d }`drhsy ok }`dvd
}ysdv i sh}odk}v+ Gir sh}odk}v zo}` }ysd 2 mohbd%
}dv. h bhvhn htjedk}h}oik okvtnok rdjoedk fhk
bd hmmdm }i ed}ireok h} h v}hr}okj mivd i 83 tko}v ir 3+2
tko}v)aj hmeokov}drdm h} koj`}+ Fdr}hok sh}odk}v zonn rdxtord
}`d hmmo}oikhn bintv okvtnok }i sriwomd jnyfdeof fik}rin+
]`ov mdfovoik ov ehmd bhvdm ik }`d sh}odk}v vdn%eiko}ir%
okj i bniim jntfivd whntdv hkm rdxtdkfy i `ysdrjnyfd%
eof vyes}iev+ Ehky okvtnok }o}rh}oik vf`dmtndv dpov}+ Eiv}
sh}odk}v zonn hf`odwd jnyfdeof fik}rin by }o}rh}okj hk okvtnok
mivd by }zi tko}v dwdry }`rdd mhyv tk}on bniim jntfivd
whntdv hrd fikvov}dk}ny ok }`d }hrjd} rhkjd ir `ysdrjnyfd%
eof vyes}iev rdvinwd+ ]`drd ov ki fdonokj mivd i okvtnok.
bt} rdxtdk} `ysijnyfdeoh ehy noeo} mivd }o}rh}oik+ Okvtnok
srisdr}odv hrd mdvfrobdm ok ]hbnd 4+
Hmwdrvd Dggdf}v
@ysijnyfdeoh ov }`d eiv} fieeik hmwdrvd dggdf} vddk
zo}` okvtnok tvd+ Okvtnok mivdv v`itnm ki} bd okfrdhvdm ok
}`d srdvdkfd i rdxtdk} `ysijnyfdeoh. hkm h mivd md%frdhvd ehy bd hssrisroh}d o hk tkmdrnyokj fhtvd fhkki}
bd omdk}odm hkm hmmrdvvdm+ Tsik okvtnok hmeokov}rh}oik.
ir mivd hmltv}edk}. sh}odk}v v`itnm bd dmtfh}dm }i srd%
wdk}. rdfijko|d hkm }rdh} `ysijnyfdeoh+ Okvtnok ov hvvifo%
h}dm zo}` eimdv} zdoj`} jhok. bt} }`d bdkd}v i jnyfd%
eof fik}rin i}dk it}zdoj` }`d vehnn okfrdhvd ok zdoj`}+
Nosi`ysdri}ris`y ehy rdvtn} rie rdtvd i kddmndv ir
]hbnd 4< Hwhonhbnd Okvtnok Hjdk}v
Jdkdrof Khed Brhkm Khed Ikvd} Sdha (`itrv/ Mtrh}oik
Rhsom%Hf}okj
Hvshr}
Novsri
Jntnovokd
Kiwinij
@tehnij
Hsomrh
8463 eokt}dv 3+42+4
86
82
6=
64
6=
V`ir}%Hf}okj
Rdjtnhr
@tetnok R
Kiwinok R
6373 eokt}dv 26 67
Ok}dredmoh}d%Hf}okj
Kdt}rhn Sri}heokd @hjdmirk (KS@/
@tetnok K
Kiwinok K
2= itrv =7 082
Nikj%Hf}okj
JnhrjokdMd}deor
Nhk}tv
Ndwdeor
=4 `itrv
6= `itrv
Ki sdha 222=
Ts }i 2=
Fiebokh}oik Srimtf}v
Rdjtnhr hkm KS@
Novsri hkm kdt}rhn sri}heokd novsri
Hvshr} hkm kdt}rhn sri}heokd hvshr}
@tetnok :3)63
Kiwinok :3)63
@tetnok 43)43
@tehnij Eop :4)24
Kiwinij Eop :3)63
6373 eokt}dv
8463 eokt}dv
8463 eokt}dv
8+487
282
24+4
87+4
8=
8387
8480
Ts }i 2=
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] =8
-
7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
14/23
rdsdh}dm okldf}oikv ok }`d vhed hrdh+ Dmtfh}d sh}odk}v
}i ri}h}d okldf}oik vo}dv h} dhf` hmeokov}rh}oik+ Dpfdv%
vowd okvtnok mivdv ehy fhtvd `ysiahndeoh+ Hn}`itj` ki}
fikfntvowd. vied dwomdkfd vtjjdv}v okvtnok ehy fhtvd h
vehnn okfrdhvd ok fhkfdr rova+
Mrtj Ok}drhf}oikv
Okvtnok tvd si}dk}oh}dv }`d rova i `ysijnyfdeoh z`dk
fiebokdm zo}` edmofh}oikv }`h} okfrdhvd dkmijdkitv
okvtnok vdfrd}oik ir sdros`drhn t}ono|h}oik+ Tvd i okvtnok
hkm }`oh|inomokdmoikdv rdvtn} ok jrdh}dr okfrdhvdv i gtom
rd}dk}oik fieshrdm }i do}`dr hjdk} hnikd+
Fik}rhokmofh}oikv
Okvtnok ov fik}rhokmofh}dm mtrokj hk hft}d dsovimd i `y%
sijnyfdeoh hkm ok }`ivd zo}` h `ysdrvdkvo}owo}y }i okvtnok
ir hky ig o}v fiesikdk}v+ @ysdrvdkvo}owo}y rdhf}oikv }i `t%ehk rdfiebokhk} okvtnok iretnh}oikv hrd rhrd hkm ifftr
ndvv i}dk }`hk zo}` sirfokd% hkm biwokd%mdrowdm okvtnok
srimtf}v. z`of` hrd ki nikjdr fieedrfohnny hwhonhbnd+
Fnivd eiko}irokj i vdrte si}hvvote ov rdfieedkmdm ok
}`ivd }haokj okvtnok z`i hrd h} `oj` rova ir `ysiahndeoh
(vtf` hv niis motrd}of tvd/+
Srdjkhkfy Fh}djiry
Okvtnok ov vhd hkm ddf}owd ir }`d }rdh}edk} i
mohbd}dv mtrokj srdjkhkfy hkm ov fikvomdrdm
}`d mrtj i f`iofd+ Eiv} okvtnokv hrd fik%
vomdrdm srdjkhkfy fh}djiry B. zo}` md}deor.
jnhrjokd. jntnovokd. hkm Kiwinij Eop `hwokj h
rh}okj i fh}djiry F+
]RDH]EDK] HNJIRO]@E)MOVFTVVOIK
IG ]RDH]EDK] SRIJRDVVOIK
Ok 233?. }`d HMH hkm }`d Dtrisdhk Hvvi%
foh}oik ir }`d V}tmy i Mohbd}dv rdndhvdm h
fikvdkvtv v}h}dedk} zo}` rdfieedkmh}oikv
ir }`d }rdh}edk} i }ysd 2 mohbd}dv. okfntmokj
hk hnjiro}`e (Gojtrd 8/+ ]`d }rdh}edk} hnji%
ro}`e ov briadk mizk ok}i }odr 8 (zdnn%whnomh}dm
}`drhsodv }`h} rdsrdvdk} }`d bdv}%dv}hbnov`dmhkm eiv} ddf}owd hkm fiv}%ddf}owd }`drh%
sdt}of v}rh}djodv/ hkm }odr 2 (ndvv zdnn%whno%
mh}dm }`drhsodv }`h} ehy bd fikvomdrdm ok
fdr}hok fnokofhn vo}th}oikv/+ ]odr 8 rdfieedk%
mh}oikv fikvov} i }`d oko}oh}oik i ed}ireok
hkm nodv}ynd eimogfh}oikv ik mohjkivov.
=2 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
H} mohjkivov833 ej)mN+ Hk is}oikhn jihn ig >:3ej)mN
ehy bd fikvomdrdm ok wdry `oj`%rova sh}odk}v. okfntmokj
}`ivd zo}` iwdr} FWM hkm etn}osnd ir siirny fik}rinndm
rova hf}irv (vtf` hv ed}hbinof vykmried/+ Vfrddkokj
ov fikmtf}dm tvokj h hv}okj nosom srind hkm v`itnm
bd sdriredm hkkthnny ir hnn mohbd}dv sh}odk}v+ Ndvv
v}rokjdk} eiko}irokj ehy bd fikvomdrdm ok sh}odk}v z`i
`hwd hf`odwdm }`dor NMN%F jihn+ ]`drhsdt}of nodv}ynd
eimofh}oikv hrd rdfieedkmdm ok hnn sh}odk}v hbiwd
jihn NMN%F+ V}h}okv hrd fikvomdrdm }`d mrtj i f`iofdir }`d }rdh}edk} i myvnosomdeoh+ Ok mohbd}dv sh}odk}v
zo}` fhrmohf rova ghf}irv bt} zo}`it} h `ov}iry ig FWM.
v}h}ok }`drhsy rdmtfdm }`d rova i rv} ehlir fhrmoiwhv%
ftnhr dwdk}v rdjhrmndvv i oko}ohn NMN%F+ ]`dvd rdvtn}v
`dnsdm okire }`d HMH. z`of` rdvtn}dm ok }`d nh}dv}
rdfieedkmh}oikv }`h} v}h}okv bd fikvomdrdm okmdsdk%
mdk} i bhvdnokd nosom ndwdnv ok }`ivd iwdr }`d hjd i
=3 zo}`it} FWM hkm ikd ir eird FWM rova ghf}irv+ Ok
sh}odk}v tkmdr =3 zo}`it} iwdr} FWM. }`drhsdt}of nogdv}ynd
f`hkjdv (]NF/ sntv h v}h}ok hrd rdfieedkmdm z`dkNMN%F ov hbiwd jihn+ Ok sh}odk}v zo}` dv}hbnov`dm FWM
}`d rdfieedkmh}oikv hrd ndvv hebojtitv+ Ok hmmo}oik
}i hvsorok. h bd}h%bnifadr. hkm hk HFD ok`obo}ir. v}h}ok
}`drhsy ov fikvomdrdm }`d v}hkmhrm i fhrd }i srdwdk} h
t}trd dwdk} hkm v`itnm bd idrdm }i hnn sh}odk}v zo}`it}
h fik}rhokmofh}oik+
HK]OSNH]DND] ]@DRHS_
Ok srdwoitv ydhrv. }`d tvd i hvsorok ir sroehry srdwdk%
}oik ig FWM zhv rdfieedkmdm ok mohbd}dv sh}odk}v h}
okfrdhvdm rova1 mdgkdm hv iwdr =3 ydhrv inm zo}` hm%
mo}oikhn rova ghf}irv (gheony `ov}iry ig FWM. veiaokj.
`ysdr}dkvoik. myvnosomdeoh. ir hnbteoktroh/+ Kdzdr
dwomdkfd xtdv}oikv }`d tvd i hvsorok ir sroehry srdwdk%
}oik+ Rdfdk}ny stbnov`dm fnokofhn }rohnv hondm }i mdeik%
v}rh}d h rdmtf}oik ok fhrmoiwhvftnhr dkmsiok}v ok mohbd}dv
sh}odk}v tvokj hvsorok ir sroehry srdwdk}oik+ Bhvdm ik
}`d rdvtn}v i }`dvd }rohnv. z`of` zdrd okfntmdm hnikj zo}`
i}`dr }rohnv ok h ed}h%hkhnyvov sdriredm by }`d HMH. }`d
rdfieedkmh}oikv rdjhrmokj hvsorok tvd ir sro%
ehry srdwdk}oik zdrd rdwovdm+ Fikvomdr rdfie%
edkmokj hvsorok ir sroehry srdwdk}oik ok edk
iwdr 43 hkm ziedk iwdr 73 zo}` h 83%ydhr FWM
rova i ;83 sdrfdk} hkm hmmo}oikhn rova hf}irv
hv mdgkdm hbiwd+ ]`d rdfieedkmdm mivd
i hvsorok ov :4 872 ej mhony+ ]`d bdkdg}v i
hvsorok tvd ir vdfikmhry srdwdk}oik hrd zdnn
dv}hbnov`dm. hkm o} v`itnm bd tvdm ok mohbd}dv
sh}odk}v zo}` h `ov}iry ig FWM+ Fnisomijrdn ehy
bd tvdm ok sh}odk}v zo}` h `ov}iry ig FWM hkm
hk hvsorok hnndrjy+
RD]OKISH]@_
Mohbd}of rd}okish}`y ov mdkdm hv mhehjd }i
}`d rd}okh fhvdm by nikj%}dre `ysdrjnyfdeoh+
Rd}okish}`y hdf}v bi}` }ysd 8 hkm }ysd 2sh}odk}v hkm ov tvthnny rdnh}dm }i mtrh}oik i
mohbd}dv+ Ok }`d Tko}dm V}h}dv. mohbd}of rd}o%
kish}`y ov }`d ndhmokj fhtvd i bnokmkdvv ok
hmtn}v bd}zddk }`d hjdv i 23 hkm :=+ ]`d HMH
rdfieedkmv vfrddkokj ir mohbd}dv rd}okish}`y
v`ir}ny h}dr mohjkivov ir sdisnd zo}` }ysd 2
mohbd}dv. hkm zo}`ok wd ydhrv i mohjkivov ir
}ysd 8 mohbd}dv sh}odk}v inmdr }`hk 83+ H monh}dm
dyd dpheokh}oik sdriredm by hk is`}`hneini%
jov} ir is}ied}rov} ov rdfieedkmdm ydhrny+Fik}rin i bniim jntfivd hkm bniim srdvvtrd
`hv bddk v`izk }i rdmtfd }`d rova i mdwdnis%
okj rd}okish}`y ok }ysd 8 hkm 2 mohbd}ofv+
KDS@RISH]@_
Mohbd}of kds`rish}`y ov }`d eiv} fieeik
fhtvd i dkm%v}hjd rdkhn movdhvd ok }`d Tko}dm
V}h}dv+ Hnbteoktroh (sri}dok ok }`d trokd/ ov tvdm
hv h ehradr gir kds`rish}`y+ Sh}odk}v zo}` }ysd
8 mohbd}dv ok jdkdrhn. hkm sh}odk}v zo}` }ysd 2
zo}` eofrihnbteoktroh (vehnn heitk}v i sri}dokok }`d trokd/. hrd h} okfrdhvdm rova ir movdhvd
srijrdvvoik hkm ehfrihnbteoktroh (nhrjd
heitk}v i sri}dok ok }`d trokd/. hv zdnn hv }`d
mdwdnisedk} i tneokh}d aomkdy movdhvd+ Rova
hf}irv ir mohbd}of kds`rish}`y okfntmd ysdr%
}dkvoik. siir jntfivd fik}rin. hkm eofrihnbt%
eoktroh+ H mohjkivov i eofrihnbteoktroh ehy
bd h ehradr ir okfrdhvdm eir}hno}y hkm t}trd
== hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
17/23
kds`rish}`y+ ]`d srddrrdm ed}`im ir vfrddk%
okj ov h trokd hnbteok%}i%frdh}okokd rh}oi woh h
rhkmie vsi} finndf}oik+ Mdjrddv i hnbteok%
trdh hrd mdkdm hv innizv< eofrihnbteoktroh
632?? j)en hkm ehfrihnbteoktroh 633 j)
en+ Oko}ohn vfrddkokj ir }ysd 8 mohbd}dv sh}odk}v
ov rdfieedkmdm zo}`ok wd ydhrv i mohjkivov+
Gir }`ivd zo}` }ysd 2 mohbd}dv. oko}ohn
vfrddkokj v`itnm ifftr h} mohjkivov+ Eiko%
}irokj ov rdfieedkmdm ydhrny }`drdh}dr+
]`d sroehry ok}drwdk}oik ir srdwdk}oik hkm
srijrdvvoik i kds`rish}`y ov bniim srdvvtrd
hkm bniim jntfivd fik}rin+ ]rdh}edk} v}rh}d%
jodv }i srdwdk} zirvdkokj i kds`rish}`y
modr bhvdm ik }ysd i mohbd}dv hkm mdjrdd
i hnbteoktroh+ Bi}` HFD ok`obo}irv hkm HRBv
`hwd bddk v`izk }i vniz }`d srijrdvvoik ihnbteoktroh ok }ysd 2 mohbd}dv sh}odk}v zo}`
miftedk}dm eofrihnbteoktroh+ Rdmtf}oik ok
iwdrhnn eir}hno}y `hv bddk vddk zo}` }`d tvd
i HFD ok`obo}irv. z`drdhv }`drd ov noeo}dm
dwomdkfd vtjjdv}okj h rdmtf}oik ok eir}hno}y
zo}` HRB }`drhsy+ Hffirmokj }i }`d HMH. HFD
ok`obo}irv ir HRBv ehy bd fikvomdrdm ir tvd
ok }ysd 2 sh}odk}v zo}` eofrihnbteoktroh+ ]`d
}rdh}edk} i f`iofd ir ehfrihnbteoktroh ok
}ysd 2 mohbd}dv ov hk HRB. hv }`dy `hwd bddkv`izk }i rdmtfd rova ir dkm%v}hjd rdkhn mov%
dhvd ok }`ov sistnh}oik+
]`d hwirdm hjdk}v ok }`ivd zo}` }ysd
8 mohbd}dv zo}` hky mdjrdd i hnbteoktroh
hrd HFD ok`obo}irv+ ]`d fiebokh}oik i HFD
ok`obo}irv hkm HRBv `hv bddk v`izk }i
rdmtfd srijrdvvoik }i hnbteoktrdh ok fdr}hok
sh}odk}v. bt} }`drd ov ki mh}h }i vtssir} nikj%
}dre rdmtf}oik ok rdkhn hkm fhrmoiwhvftnhr
dwdk}v+ O fiebokh}oik }`drhsy ov fikvomdrdm.
fnivd eiko}irokj ov rdxtordm mtd }i okfrdhvdmrova i `ysdrahndeoh+
SDROS@DRHN KDTRISH]@_
Kdrwd mhehjd ov h fiesnofh}oik i bi}` }ysd 8
hkm }ysd 2 mohbd}dv ednno}tv+ ]`drd hrd vdwdrhn
modrdk} }ysdv i mohbd}of kdtrish}`odv+ ]`d
eiv} rdxtdk} kdtrish}`y ov vyeed}rof mov}hn
sinykdtrish}`y (MSK/. fieeikny rdgdrrdm }i
hvsdros`drhn kdtrish}`y+ Sdros`drhn kdtrish}`y srdvdk}v
hv shok. ktebkdvv. hkm }okjnokj ok }`d dp}rdeo}odv. eiv}
fieeikny ok }`d ndjv. dd}. hkm }idv+ Okfomdkfd ov }`itj`}
}i okfrdhvd zo}` mtrh}oik i mohbd}dv+ Dmtfh}oik hbit}
srisdr ii} fhrd hkm hvvdvvedk} i vdkvh}oik fhk rd%
mtfd rova ir }`d mdwdnisedk} i mohbd}of ii} tnfdrv+ ]`d
HMH rdfieedkmv hkkthn }dv}okj ir nivv i sri}df}owd
vdkvh}oik (NISV/ tvokj h 83 j eikinhedk}. sntv }dv}okj
hky ikd ig }`d ginnizokj< wobrh}oik tvokj h 820%`dr}| (@|/
}tkokj ira. soksrofa vdkvh}oik. hkand rdgdpdv. ir wobrh}oik
sdrfds}oik }`rdv`inm+ Sh}odk}v v`itnm bd dmtfh}dm ik
srisdr ii} fhrd hkm okv}rtf}dm }i dpheokd }`dor dd} mhony
ir virdv. ft}v. hkm mrykdvv+ H fiesrd`dkvowd ii} dphe
v`itnm bd sdriredm hkkthnny by h `dhn}` fhrd sriwomdr.
}i okfntmd hvvdvvedk} i vdkvh}oik hv mdvfrobdm hbiwd.
sdmhn stnvdv. hkm wovthn okvsdf}oik+ H wovthn okvsdf}oik ov
rdfieedkmdm h} dwdry inniz%ts wovo}+ Hf`odwokj jnyfd%eof fik}rin ov fikvomdrdm h rv}%nokd srdwdk}owd edhvtrd+
Edmofh}oikv ehy bd tvdm }i sriwomd vyes}ieh}of shok
rdnod+ ]`dvd okfntmd heo}ros}ynokd. kir}ros}ynokd. oeosrh%
eokd. jhbhsdk}ok. fhrbheh|dsokd. srdjhbhnok. mtnip%
d}okd. isoiomv. kikv}driomhn hk}o okgheeh}iry hjdk}v. hkm
fhsvhofok frdhe+
WHFFOKH]OIKV
Sh}odk}v zo}` mohbd}dv hrd eird vtvfds}obnd }i okgdf}oikv
hkm v`itnm bd dmtfh}dm hbit} }`d oesir}hkfd i v}hy%okj ts%}i%mh}d zo}` }`d rdfieedkmdm whffokh}oikv+ ]`d
HMH hkm Fdk}drv ir Movdhvd Fik}rin (FMF/ vsdfofhnny
rdfieedkm }`h} sh}odk}v zo}` mohbd}dv rdfdowd vdhvikhn
okgtdk|h hkm skdteififfhn whffokh}oikv. hv okgtdk|h
hkm skdteikoh hrd hvvifoh}dm zo}` hk okfrdhvdm rova
i eirbomo}y hkm eir}hno}y ok }`d dnmdrny hkm sh}odk}v
zo}` fdr}hok fieirbomo}odv okfntmokj mohbd}dv+ H ydhrny
vdhvikhn okgtdk|h whffokh}oik v}hr}okj ok Vds}debdr ov
rdfieedkmdm ir hnn mohbd}dv sh}odk}v hjd 7 eik}`v
hkm inmdr+ ]`d skdteififfhn whffokh}oik ov hnvi rdfie%
edkmdm ir hnn sh}odk}v zo}` mohbd}dv hjd 2 ydhrv hkminmdr+ ]`d skdteififfhn whffokh}oik v`itnm bd hmeok%
ov}drdm ik mohjkivov+ H vdfikm whffokh}oik ov rdfie%
edkmdm ok sh}odk}v hjd 74 hkm inmdr o eird }`hk wd
ydhrv `hwd shvvdm vokfd }`dor nhv} whffokh}oik+
VEIAOKJ FDVVH]OIK
]`d `dhn}` rovav i fojhrd}}d veiaokj hkm okfrdhvdm rova i
eirbomo}y hkm eir}hno}y ir sh}odk}v z`i f`iivd }i veiad
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] =4
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
18/23
hrd zdnn akizk+ Hnn sh}odk}v zo}` mohbd}dv v`itnm bd fitk%
vdndm ik }`d bdkd}v i veiaokj fdvvh}oik hkm hmwovdm }i
xto}+ ]`drd hrd vdwdrhn }`drhsdt}of is}oikv hwhonhbnd }i hv%
vov} ok veiaokj fdvvh}oik. okfntmokj kofi}okd rdsnhfdedk}
}`drhsy. btsrisoik (\ybhk VR/. hkm whrdkofnokd (F`hk}op/+
]`d ddf}owdkdvv i }`dvd fieeikny tvdm edmofh}oikv
hssdhrv voeonhr+ ]`d tvd i edmofh}oik }i hvvov} zo}`
veiaokj fdvvh}oik. }`drdird. v`itnm bd f`ivdk bhvdm
ik okmowomthn srddrdkfdv hkm si}dk}ohn fik}rhokmofh}oikv
}i }`drhsy+ ]`d bdkd}v i veiaokj fdvvh}oik fitkvdnokjok fiebokh}oik zo}` s`hrehfinijof }`drhsy hrd jrdh}dr
}`hk do}`dr srhf}ofd hnikd+ Fitkvdnokj sriwomdm by }rhokdm
fieetko}y s`hrehfov}v `hv bddk v`izk }i okfrdhvd h
sh}odk}v noadno`iim i xto}}okj+
HFT]D FIESNOFH]OIKV
@ysijnyfdeoh ov h rova gir hnn sh}odk}v zo}` mohbd}dv }ha%
okj edmofh}oikv }`h} ehy srdmovsivd }`de }i niz bniim
jntfivd (vtf` hv okvtnok hkm vtnikyntrdhv/+ Fnokofhn
mohjkivov i `ysijnyfdeoh ov mdgkdm hv h bniim jntfivd
ig >43 ej)mN+ @izdwdr }`d HMH rdfieedkmv }rdh}edk}
z`dk bniim jntfivd ov >:3 ej)mN+ Fieeik vojkv hkm
vyes}iev i `ysijnyfdeoh okfntmd h}ojtd. v`haokdvv.
vzdh}okj. `dhmhf`d. `tkjdr. hkm fikgtvoik+ Sh}odk}v zo}`
dndwh}dm bniim jntfivd ndwdnv ehy dpsdrodkfd `ysijnyfd%
eof vyes}iev zo}`it} `hwokj h bniim jntfivd ig >:3ej)
mN hv }`dor bniim jntfivd ov bdokj rdmtfdm }i kdhr%kirehn
ir kirehn rhkjdv+ Sh}odk}v dpsdrodkfokj `ysijnyfd%
eof vyes}iev v`itnm bd hmwovdm }i f`dfa gkjdr%v}ofa
]hbnd :< Mohbd}dv Tsmh}d 2383
H8F kdzny dkmirvdm hv h mohjkiv}of }dv}
Dv}oeh}dm hwdrhjd jntfivd kiz rdfieedkmdm ok fik%
ltkf}oik zo}` H8F eiko}irokj
Kdz dwomdkfd vtjjdv}v H8F fnivd }i :$ ov hffds}hbnd
ir eiv} sh}odk}v (HFFIRM }rohn/
Kdz Hk}omohbd}of Hjdk}v
h/ Ikjny|h (vhphjnos}ok/< Kdz MSS%= ok`obo}ir
b/ Fyfnivd} (brieifros}okd edvynh}d/:3 ej)mN. v`itnm
fikvted 8423 j i jntfivd ir fhrbi`ymrh}d
(dxthn }i }`rdd jntfivd }hbnd}v ir itr itkfdv
ig irhkjd ltofd/+ Sh}odk}v v`itnm bd okv}rtf}dm
}i f`dfa gkjdr%v}ofa bniim jntfivd hjhok ok 84
eokt}dv }i dkvtrd rdvint}oik i `ysijnyfdeoh+
]`ov ok}drwdk}oik ehy bd rdsdh}dm hv kddmdm o
oko}ohn vyes}iev mi ki} rdvinwd ir bniim jntfivd
midv ki} rovd hbiwd :3 ej)mN+ Ikfd hbiwd
bniim jntfivd ov ;:3 ej)mN. vtjjdv} dh}okj
h vehnn vkhfa }i ehok}hok dtjnyfdeoh+ Gir h
fikvfoitv sh}odk} dpsdrodkfokj h `ysijnyfdeof
dsovimdv zo}` h bniim jntfivd ig >43 ej)mN.
63 jrhev i fhrbi`ymrh}d ir jntfivd fikvtes%
}oik ov rdfieedkmdm+ Ok tkfikvfoitv sh}odk}v.
h jntfhjik ao} v`itnm bd t}ono|dm hkm dedrjdkfy
ehkhjdedk} vdrwofdv hf}owh}dm+Mohbd}of ad}ihfomivov (MAH/ hkm `ysdriv%
einhr `ysdrjnyfdeof v}h}d (@@V/ hrd si}dk}ohnny
h}hn fikmo}oikv }`h} ifftr ok mohbd}dv sh}odk}v
zo}` dndwh}dm bniim jntfivd+ ]`dy hrd bi}`
fikvomdrdm edmofhn dedrjdkfodv. hkm sh}odk}v
v`itnm rdfdowd oksh}odk} }rdh}edk}+ Mohbd}of
ad}ihfomivov ov fhtvdm by okvtnok mdgfodkfy
hkm ov eiv} fieeik ok yitkj }ysd8 mohbd}dv
sh}odk}v+ @izdwdr. o} fhk ifftr ok hmtn} }ysd 8
sh}odk}v hkm }ysd 2 mohbd}dv sh}odk}v+ ]`d eiv}fieeik fhtvdv i MAH hrd hnfi`in hbtvd.
okdf}oik. hkm kikfiesnohkfd zo}` }rdh}edk}+
Vojkv hkm vyes}iev ig MAH okfntmd grto}y)
hfd}ikd brdh}`. khtvdh. wieo}okj. md`ymrh}oik.
sinymosvoh. sinytroh. hkm rhsom brdh}`okj+ @ysdr%
iveinhr `ysdrjnyfdeof v}h}dv ifftr sroehrony ok
inmdr }ysd 2 sh}odk}v hkm rdvtn} rie dp}rdedny
dndwh}dm jntfivd hkm md`ymrh}oik. z`of`
okfrdhvd snhveh iveinhno}y hkm hn}drdm edk}hn
v}h}tv+ H `ysdriveinhr `ysdrjnyfdeof v}h}d ov
tvthnny ki} hvvifoh}dm zo}` ad}ihfomivov+ Vojkv
hkm vyes}iev ig @@V okfntmd zdhakdvv. wovthn
mov}trbhkfd. hkm ndj frhesv+ Khtvdh. wieo}okj.
nd}`hrjy. fiktvoik. `deoshrdvov. vdo|trdv. hkm
fieh hrd ndvv fieeik vyes}iev ig @@V+ Gir%
}tkh}dny. sh}odk}v rhrdny srdvdk} zo}` }`dvd hft}d
fikmo}oikv ok }`d fieetko}y s`hrehfy+ @iz%
dwdr. o} ov oesir}hk} ir s`hrehfov}v }i rdfijko|d
}`d vojkv hkm vyes}iev ig MAH hkm @@V }i
=7 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
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hkm ok }`d dwdkokj bdgird mokkdr (223273 ej)mN/+
SE@< ]ysd 2 mohbd}dv
@ysdr}dkvoik (mohjkivdm }zi ydhrv hji/
Iv}disirivov
Edmofh}oikv< Novokisron 83 ej mhony
Rovdmrikh}d 64 ej ikfd zddany
Iv%Fhn 433 ! Dp}rh M 8 }hbnd} }zofd mhony
Ed}ireok 433 ej mhony ir vdwdk mhyv.
}`dk BOM (kdz zo}` }imhyv srdvfros}oik/
Hnndrjodv< Vtnh (`owdv hkm moftn}y brdh}`okj/
Gheony @ov}iry< Ei}`dr (70/ `hv }ysd 2 mohbd}dv
Gh}`dr (:3/ `hv F@G
Vifohn @ov}iry< Veiadv 8 shfa sdr mhy
Mdkodv hnfi`in
Fhdokd< 82 bdwdrhjdv sdr mhy
Zdoj`}< 803 nbv+
@doj`}< 46
Bniim Srdvvtrd< h} s`yvofohkv igfd }imhy zhv 823):2
Mod}< @hv ft} it} vtjhr hkm ov zh}f`okj fhr%
bi`ymrh}d ok}had
Dpdrfovd< @hv v}hr}dm zhnaokj }`rdd mhyv sdr zdda
ir hbit} 84 eokt}dv
Grheokj`he rova< ?$
Z`h} oesir}hk} ed}gireok fitkvdnokj siok}v zitnm yit
rdwodz `dr z`dk v}hr}okj }`drhsy9Ed}ireok }`drhsy ov fikvomdrdm rv}%nokd bdfhtvd o}
sriwomdv h vojkofhk} rdmtf}oik ok bniim jntfivd+ Eird
oesir}hk}ny. o} `hv bddk v`izk }i rdmtfd }`d rova i
srdeh}trd mdh}` hkm i}`dr mohbd}dv%rdnh}dm dkmsiok}v
ok sh}odk}v vtf` hv `dr+ ]`d eiv} fieeik vomd ddf}v
rie ed}ireok }`drhsy hrd jhv}riok}dv}okhn ok kh}trd1
}`dy tvthnny hrd vddk h} }`d bdjokkokj i }`drhsy ir h}dr
h mivd okfrdhvd. hkm }`dy vtbvomd h}dr h dz zddav i
}`drhsy+ Sh}odk}v v`itnm bd okv}rtf}dm }i }had zo}` giim
}i eokoeo|d }`dvd ddf}v+ Nhf}of hfomivov ov hk dp}rdedny
rhrd yd} si}dk}ohnny vdwdrd vomd dggdf} ig }`drhsy+ Sh%
}odk}v v`itnm bd fitkvdndm }i vdn%eiko}ir ir vyes}iev
i nhf}of hfomivov (`ysdrwdk}onh}oik. eyhnjoh. ehnhovd.
tktvthn viekindkfd/ hkm ki}oy h `dhn}` fhrd sriwomdr o
}`dvd vyes}iev ifftr+ Aomkdy tkf}oik zonn bd eiko}irdm
by }`dor s`yvofohk z`ond ik }`ov edmofh}oik+ Sh}odk}v ehy
bdjok }i vdd h mdfrdhvd ok }`dor GVBJ hv viik hv }zi
Fik}oktdm ik shjd 60
}rohjd hkm rddr sh}odk}v ir srisdr edmofhn h}%
}dk}oik ok }`d dwdk} h sh}odk} midv srdvdk} zo}`
}`d mdvfrobdm vyes}iev+
FIKFNTVOIK
]`d ktebdr i sh}odk}v zo}` mohbd}dv ok }`d
Tko}dm V}h}dv ov srildf}dm }i jriz vojkofhk}ny
iwdr }`d kdp} mdfhmd+ Jowdk }`d nhrjd ktebdr
i sh}odk}v ftrrdk}ny zo}` mohjkivdm mohbd}dv.
}`drd ov h vojkofhk} issir}tko}y ir }`d fieet%
ko}y s`hrehfov} }i snhy h sowi}hn rind ok mohbd}dv
fhrd+ ]`d srijrdvvowd. etn}ohf}irohn kh}trd i
}`d movdhvd rdxtordv fik}robt}oikv rie whro%
itv edebdrv i }`d `dhn}` fhrd }dhe+ Zo}` }`d
v}rikj vtssir}okj dwomdkfd ir MVED. s`hr%
ehfov}v fhk kiz rdfdowd rdoebtrvdedk} ir }`d
}oed vsdk} fitkvdnokj sh}odk}v zo}` mohbd}dv+Hv }`d rind i }`d s`hrehfov} fik}oktdv }i srij%
rdvv. fieetko}y s`hrehfy zonn snhy hk ok}djrhn
rind ok }`d fhrd i mohbd}dv sh}odk}v+
Aoebdrny Gdrdkfd. S`hreM. ov hk hvvov}hk} srigdvvir h} }`d
Zonadv Tkowdrvo}y Finndjd ig S`hrehfy hkm Ktrvokj+
FHVD V]TM_ 8HLM ov =4%ydhr%inm Fhtfhvohk dehnd z`i fiedv
}i yitr s`hrehfy fitk}dr zo}` h kdz srdvfros%
}oik ir ed}ireok+ V`d zitnm hnvi noad hvvov%
}hkfd zo}` sofaokj hk hvsorok srimtf}+ @dr grodkm.
z`i hnvi `hv mohbd}dv. }inm `dr }i }had hvsorok
mhony. bt} v`d midv ki} akiz z`h} srimtf} }i
strf`hvd+ V`d hnvi vhz h vojk ok }`d zokmiz
v}h}okj }`h} }`d s`hrehfy idrv mohbd}dv dmtfh%
}oik vdvvoikv hkm v`d zitnm noad }i vf`dmtnd hk
hssiok}edk}+
@SO< Sh}odk} zhv mohjkivdm zo}` }ysd 2 mohbd}dv
ikd eik}` hji hkm zhv okv}rtf}dm }i oko}oh}d
nodv}ynd eimofh}oikv+ H}dr hk hssiok}edk} zo}`
`dr s`yvofohk }imhy. v`d zhv v}hr}dm ik ed}ir%
eok }`drhsy+ V`d mdkodv sinys`hjoh hkm bntrrdm
wovoik hkm hmeo}v }i dpsdrodkfokj sinymosvoh
hkm sinytroh iffhvoikhnny+ V`d f`dfav dr GVBJ
ok }`d eirkokj bdgird dh}okj (2332=3 ej)mN/
zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] =:
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
20/23
FHVD V]TM_ 8B
LM rd}trkv }i yitr s`hrehfy. }`rdd eik}`v
h}dr `dr oko}ohn wovo}. zo}` h srdvfros}oik ir
ed}ireok 8.333 ej }zofd mhony+ Tkmdr }`d
mordf}oik i `dr s`yvofohk. v`d `hv bddk }haokj
ed}ireok 433 ej }zi }hbnd}v }zofd mhony ir
}`d shv} vop zddav hkm `hv ki} dpsdrodkfdm
hky vomd ddf}v+ V`d v}h}dv }`h} `dr GVBJ
hrd ki} xto}d z`drd }`dy v`itnm bd hkm }`h}
`dr mif}ir ov fikvomdrokj hmmokj okvtnok }i `dr
rdjoedk o }`d kdz mivd i ed}ireok midv
ki} zira+ V`d v}h}dv }`h} v`d ov ki} rdhmy irokvtnok hkm hvav o yit akiz hky}`okj hbit}
}`d }zi kdz mohbd}dv edmofh}oikv }`h} v`d
vhz ik }dndwovoik. Ikjny|h hkm Wof}i|h+ V`d
zhk}v }i akiz o }`dvd edmofh}oikv fhk bd
tvdm okv}dhm i okvtnok+ Tsik tr}`dr xtdv}oik%
okj. yit tkfiwdr }`h} v`d ov issivdm }i tvokj
okvtnok mtd }i dhr hkm }`d hvvifoh}oik zo}` `dr
ei}`drv zirvdkokj mohbd}dv+ @dr ei}`dr zhv
zddav h}dr v}hr}okj. hkm }`dy fhk hnvi }dnn }`d edmofh}oik
ov ziraokj o }`dor vyes}iev i `ysdrjnyfdeoh mdfrdhvd ok
grdxtdkfy)vdwdro}y+
H} }`ov }oed. zitnm yit rdfieedkm hvsorok ok LM9 Og vi.
z`h} mivd zitnm yit rdfieedkm9
]`ov sh}odk} midv ki} edd} }`d fro}droh ir hvsorok }`drhsy
ir sroehry srdwdk}oik hv vd} by }`d HMH+ V`d ov ki}
eird }`hk 73 ydhrv inm hkm `dr Grheokj`he 83%ydhr
F@M rova ov tkmdr 83 sdrfdk}+ @izdwdr. v`d midv `hwd
rova hf}irv vtf` hv veiaokj hkm `ysdr}dkvoik+ ]`dvd
rova hf}irv v`itnm bd hmmrdvvdm hv shr} i h fiesrd%
`dkvowd fhrd snhk+ _it v`itnm fikvomdr rdhvvdvvokj
}`d sh}odk}v F@M rova ikfd }`d sh}odk} ov iwdr 73 ydhrv
inm hkm rdfieedkm hvsorok h} }`h} }oed o hssrisroh}d+
Mivdv ig 08 ej mhony `hwd bddk v`izk dggdf}owd ok sri%womokj fhrmoisri}df}oik+
Z`h} fiesnofh}oik dmtfh}oik hkm vfrddkokj zitnm yit
rdfieedkm h} }`ov }oed9
Bniim srdvvtrd vfrddkokj ov rdfieedkmdm h} dwdry i%
fd wovo}+ Sh}odk} `hv `ysdr}dkvoik hkm ov h} jihn bniim
srdvvtrd (hffirmokj }i rdhmokj ok igfd }imhy/ i tkmdr
863)03 ee@j+ Rdfieedkm fik}oktitv hvvdvvedk} }i
dkvtrd jihnv hrd bdokj ed} hkm }`d }rdh}edk} rdjoedk ov
hssrisroh}d+
Myvnosomdeoh
]`d HMH rdfieedkmv vfrddkokj zo}` h hv}okj nosisri}dok
srind ik mohjkivov+ Ok }`ov sh}odk}. }`drhsy zo}` h v}h}ok
ehy bd fikvomdrdm okmdsdkmdk} i bhvdnokd nosom ndwdnv. hv
v`d ov iwdr =3 ydhrv inm zo}`it} FWM hkm ikd ir eird FWM
rova hf}irv (veiaokj. `ysdr}dkvoik/+
Rd}okish}`y
]`d HMH rdfieedkmv vfrddkokj ir mohbd}of rd}okish%
}`y v`ir}ny h}dr mohjkivov ir }ysd 2 mohbd}dv sh}odk}v+ H
monh}dm dyd dpheokh}oik ov rdfieedkmdm ydhrny+
Kds`rish}`y
]`d HMH rdfieedkmv oko}ohn vfrddkokj ir kds`rish}`y
v`ir}ny h}dr mohjkivov ir }ysd 2 mohbd}dv sh}odk}v. tvokj h
trokd hnbteok%}i%frdh}okokd rh}oi woh h rhkmie vsi} finndf%
}oik+ Eiko}irokj ov rdfieedkmdm hkkthnny }`drdh}dr+
Gii} Dphe
]`d HMH rdfieedkmv fiesrd`dkvowd ii}
dphev hkkthnny. z`of` okfntmd hvvdvvedk} i
vdkvh}oik. sdmhn stnvdv. hkm wovthn okvsdf}oik+
H wovthn okvsdf}oik ov rdfieedkmdm h} dwdry
inniz%ts wovo}+ Dmtfh}oik hbit} srisdr ii} fhrd
ov hnvi rdfieedkmdm+
Veiaokj Fdvvh}oik
LM v`itnm bd hmwovdm hbit} }`d bdkd}v i
veiaokj fdvvh}oik hkm hmwovdm }i xto}+ Veia%
okj fdvvh}oik fitkvdnokj ok fiebokh}oik zo}`
s`hrehfinijof }`drhsy ehy bd i bdkd} ok }`ov
sh}odk}+
Whffokh}oikv
]`d HMH hkm FMF rdfieedkm idrokj skdt%eififfhn hkm vdhvikhn okgtdk|h whffokdv }i
hnn mohbd}dv sh}odk}v zo}`it} h fik}rhokmofh%
}oik+ Hv o} ov ftrrdk}ny gt vdhvik. }`d sh}odk} ov
mtd ir `dr hkkthn okgtdk|h whffokh}oik+ ]`d
sh}odk} v`itnm hnvi bd hmwovdm }i rdfdowd h
skdteififfhn whffokh}oik o o} `hv ki} bddk
hmeokov}drdm ok }`d shv}+
=0 hedrofhvS@HREHFOV]~Kiwdebdr 2383 zzz+hedrofhvs`hrehfov}+kd}
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7/31/2019 The Community Pharmacist's Role in Diabetes Treatment
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FIK]OKTOKJ DMTFH]OIK XTO\
Vdndf} }`d firrdf} hkvzdr+
8+ Hk hbvint}d okvtnok mdfodkfy hrovokj rie bd}h fdnn
mdv}rtf}oik bdv} mdvfrobdv z`of` }ysd i mohbd}dv9
h+ ]ysd 8
b+ ]ysd 2
f+ Jdv}h}oikhn
m+ Srdmohbd}dv
2+ Z`of` i }`d innizokj sh}odk}v zitnm bdkd} eiv}
rie h mohbd}dv vfrddkokj9
h+ H ==%ydhr%inm ziehk zo}` ki rova hf}irv
b+ Hk iwdrzdoj`} =3%ydhr%inm ehnd zo}` ki i}`dr rova
hf}irv
f+ Hk ibdvd 64%ydhr%inm Hrofhk Hedrofhk dehnd
m+ H 60%ydhr%inm gdehnd zo}` h `ov}iry ig jdv}h}oikhnmohbd}dv hkm h BEO i 26
6+ Hffirmokj }i }`d HMH. z`of` i }`d innizokj nhb whn%
tdv ov fikvomdrdm mohjkiv}of ir mohbd}dv o fikredm
by h vdfikm rdhmokj ik h vtbvdxtdk} mhy9
h+ Irhn jntfivd }indrhkfd }dv} (}zi `itrv siv}srhkmohn/
803 ej)mN
b+ Ghv}okj snhveh jntfivd 883 ej)mN
f+ Dv}oeh}dm hwdrhjd jntfivd 827 ej)mN
m+ @deijnibok H8F
7+4 sdrfdk}
=+ ]`d HMH rdfieedkmv h jihn }zi%`itr siv}srhkmohn
snhveh jntfivd i ndvv }`hk823)03
b+ >863)03
f+ >863)04
m+ 8=3)?3
8:+ Bhvdm ik rdfdk} dwomdkfd. z`of` i }`d in%
nizokj mohbd}dv sh}odk}v ov eiv} noadny }i bdkd}
rie }`d tvd i hvsorok }i rdmtfd }`d rova i
fhrmoiwhvftnhr movdhvd9
h+ H 63%ydhr%inm ehnd zo}` `ysdr}dkvoik hkm h
83%ydhr F@M rova ig 0 sdrfdk}
b+ H =3%ydhr%inm dehnd zo}` `ysdrnosomdeoh hkm
h 83%ydhr F@M rova ig 4 sdrfdk}
f+ H 43%ydhr%inm ehnd veiadr zo}` h 83%ydhrF@M rova ig 88 sdrfdk}
m+ H 43%ydhr%inm dehnd veiadr zo}` h 83%ydhr
F@M rova ig 0 sdrfdk}
80+ Z`of` i }`d innizokj ok}drwdk}oikv `hv
KI] bddk v`izk }i rdmtfd }`d rova i zirvdk%
okj kds`rish}`y ok sh}odk}v zo}` mohbd}dv9
h+ Tvd i hk HFD ok`obo}ir
b+ Tvd i h bd}h%bnifadr
f+ Fik}rin i bniim srdvvtrdm+ Fik}rin i bniim jntfivd
8?+ ]`d HMH rdfieedkmv hkkthn vfrddkokj
ir hnn i }`d innizokj mohbd}dv fiesnofh}oikv
DPFDS]