the community pharmacist's role in diabetes treatment

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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?

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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}

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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

  • 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}

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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}

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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

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    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}

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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

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    }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}

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

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    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

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    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}

  • 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

  • 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

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  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

    19/23

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    zzz+hedrofhvs`hrehfov}+kd} Kiwdebdr 2383 ~hedrofhvS@HREHFOV] =:

  • 7/31/2019 The Community Pharmacist's Role in Diabetes Treatment

    20/23

    FHVD V]TM_ 8B

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    FIK]OKTOKJ DMTFH]OIK XTO\

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