Libin researchers looking to improve experience and outcomes for patients with diabetes

Innovative trial will pair pharmacists with patients to manage medications

Author

Dawn Smith

Diabetes and pre-diabetes are complex conditions that impact nearly 15 per cent of adult Canadians.

Diabetes often exists in tandem with other serious conditions, such as chronic kidney disease and cardiovascular disease, including heart failure, worsening the impact on patients. Fortunately, a number of medications are available to treat patients with diabetes and other complications that can significantly improve their outcomes and quality of life. However, these medications can have serious side effects, especially when patients become ill with communicable diseases like the flu.

“These patients can be on a slew of 10-15 medications, some of which can make them prone to becoming sicker if they contract an infectious disease like a cold, flu or coronavirus,” says Dr. David Campbell, MD, PhD, an endocrinologist and researcher within the Libin Cardiovascular Institute at the University of Calgary’s Cumming School of Medicine, who focuses on helping patients treat diabetes and prevent cardiovascular disease.

For example, drugs commonly used to regulate blood sugars in patients with heart disease can lead to dehydration, acute kidney injury, and life-threatening diabetic ketoacidosis in patients who aren’t eating or drinking enough because they are ill with an infectious disease.

To manage this, some medications are supposed to be discontinued when a patient is ill with a communicable disease, but it can be tough for patients to determine when to resume a prescription following their illness.

“It’s a very complex thing that we are asking people to manage,” says Campbell. “You are feeling sick, terrible and are laid up in bed, and you don’t know what to do. You may not even remember the advice you received from your doctor many months before.”

Campbell is co-leading a team of researchers trying to find a better way for these patients to manage their medications.

The RxESPOND Trial is part of a larger research program being conducted by the Interdisciplinary Chronic Disease Collaboration (www.ICDC.ca) looking at ways to improve patient experiences as well as care and outcomes for individuals with non-communicable illnesses like diabetes, cardiovascular and kidney disease. The larger program, which is funded by a $3 million operating grant from the CIHR, includes the RxESPOND Trial along with two other studies designed to address priorities identified by patients and policymakers.

The trial will investigate new ways that patients and their pharmacists can work together with the goal of testing practical interventions for pharmacists to help improve patient outcomes and cut down on the length and number of hospital stays related to diabetes and kidney disease.

The interventions include finding ways to enhance communication between patients and their pharmacist; introducing special labels on medication that should be discontinued if a patient is ill; and receiving follow-up instructions from a pharmacist about when medications should be restarted.

Researchers will follow patients for 18 months and they will evaluate interactions with the pharmacist and the process.

All three studies will be conducted in collaboration with patient partners and will include a large team of experts from several organizations including the University of Calgary, the University of Alberta, Alberta Health Services (including the Strategic Clinical Networks) and the Alberta SPOR Support Unit, which offers support for researchers in numerous areas such as data analysis, patient engagement and knowledge translation.

Libin clinician-researcher Dr. Matthew James, MD, PhD, who is co-leading the larger collaboration, is pleased to have received the funding and support. 

“These trials will use innovative ways to conduct the research, and it is exciting to be able to work closely with patients through all stages of the projects” he says. “It is a really great

Dr. David Campbell

Dr. David Campbell, MD