1. Role of Pharmacist Management and Novel Therapies of Diabetic Nephropathic Patients K.P.

Sampath Kumar*, DebjitBhowmik, Lokesh Deb, ShravanPaswan,2012 It has been predicted that worldwide the prevalence of diabetes in adults would increase to 5.4% by the year 2025 from the prevalence rate of 4.0% in 1995. Consequently the number of adults with diabetes in the world would rise from 135 million in 1995 to 300 million in the year 2025. It is expected that much of this increase in prevalence rate will occur in developing countries. While a 42% increase is expected in developed countries, a 170% increase is expected in the developing countries Nephropathy means kidney disease or damage. Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases it can lead to kidney failure. But noteveryone with diabetes has kidney damage .The kidneys have many tiny blood vessels that filter waste from yourblood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn't able to do its jobas well. Later it may stop working completely. This is called kidney failure. Certain things make you more likely toget diabetic nephropathy. Diabetes can affect many parts of the body, including the kidneys. In healthy kidneys, many tiny blood vessels filter waste products from your body. The blood vessels have holes that are big enough to allow tiny waste products to pass through into theurine but are still small enough to keep useful products (such as protein and red blood cells) in the blood. High levels of sugar in the blood candamage these vessels if diabetes is not controlled.This can cause kidney disease, which is alsocalled nephropathy (say: nef-rah-puhthee). If thedamage is bad enough, your kidneys could stopworking. There are no symptoms in the early stages. So its important to have regular urine tests to find kidney damage early. Sometimes early kidney damage can be reversed. The first sign of kidney damage is a small amountof protein in the urine, which is found by a simple urine test. As damage to the kidneys gets worse, your bloodpressure rises. Your cholesterol and triglyceride levels rise too. As your kidneys are less able to do their job, youmay notice swelling in your body, at first in your feet and legs. Community pharmacist can take to increase theirinvolvement and contribution to public health at a local level in collaboration with other public health. During thisrole shift, the competency of community pharmacists is in higher demand than ever before. In view of availability ofnumerous new medicines and drug delivery systems, community

pharmacists are challenged to ensure that patientsget maximum benefit from their medicines. It is essential that discovery of new drug, new therapeutics effect ofelatively older drugs, clinical trials, toxicological studies etc. are all carried out involving community pharmacy at different phases. Diabetic nephropathy has been categorized into stages: microalbuminuria and macroalbuminuria. If abnormal, it should beconfirmed in two out three samples collected in a three to six-months interval. Additionally, it isrecommended that glomerular filtration rate be routinely estimated for appropriate screening ofnephropathy, because some patients present adecreased glomerular filtration rate when urinealbumin values are in the normal range. The twomain risk factors for diabetic nephropathy arehyperglycemia and arterial hypertension, but thegenetic susceptibility in both type 1 and type 2diabetes is of great importance. Other risk factorsare smoking, dyslipidemia, proteinuria,glomerular hyperfiltration and dietary factors In patients with type 2 diabetes, renal lesions are heterogeneous andmore complex than in individuals with type 1diabetes. Treatment of diabetic nephropathy isbased on a multiple risk factor approach, and the goal is retarding the development or progressionof the disease and to decrease the subject'sincreased risk of cardiovascular disease
Signs and Symptoms of Diabetic Nephropathy Diabetes can affect many parts of the body,including the kidneys. In healthy kidneys, many tiny blood vessels filter waste products from yourbody. The blood vessels have holes that are bigenough to allow tiny waste products to passthrough into the urine but are still small enoughto keep useful products (such as protein and redblood cells) in the blood. High levels of sugar inthe blood can damage these vessels if diabetes is not controlled. This can cause kidney disease,which is also called nephropathy (say: nefrahpuh-thee). If the damage is bad enough, yourkidneys could stop working. Early signs andsymptoms of kidney disease in patients withdiabetes are typically unusual. However, a vastarray of signs and symptoms listed below maymanifest when kidney disease has progressed Albumin or protein in the urine High blood pressure Ankle and leg swelling, leg cramps Going to the bathroom more often at night High levels of blood urea nitrogen (BUN) and serum creatinine Less need for insulin or antidiabetic medications Morning sickness, nausea, and vomiting

Weakness, paleness, and anemia Itching 2

Lifestyles which have been established for many years are not easy to change and health care professionals cannot expect immediate adherence to the plan of management. Assess the SNAP risk factors (Smoking, Nutrition, Alcohol and Physical activity) and establish a long term lifestyle plan. It is important for the patient to have all the information available so that a common sense of purpose between the health care professionals and the patient can develop. This takes time and some patients may decide to reject advice. Professionals need to maintain an open approach and emphasise that help is available when required. Weight reduction is often difficult. A combined program of healthy eating, physical activity and education directed at behavioural changes is often successful. Carer and peer encouragement helps these behavioural changes. Health care professionals need to be sensitive to patient views concerning diabetes and be ready to counsel. The normal stresses of daily living can affect diabetes control. Seek opportunities to help patients regain control, to improve self esteem and to understand and control their condition. There is a range of approved educational materials produced by State and Territory Diabetes Organisations which can be recommended to the newly diagnosed person with diabetes. Education is ongoing and needs to continue for the rest of the person s life. Diabetes knowledge, especially self care skills (blood glucose monitoring, foot care, insulin administration) need to be assessed regularly (eg: as part of the complication screen at the twelve monthly review).

3.Diabetes

education and knowledge in patients with type 2 diabetes from the community The Fremantle Diabetes Study David G. Brucea,*, Wendy A. Davisa,b, Carole A. Cullc, Timothy M.E. Davisa, 2003 Provide education 1. Diabetic patients obtain knowledge of the condition from a variety of sources. These include education programs and encounters with health-care staff such as during instruction on self-monitoring of blood glucose (SMBG). Diabetes education programs, diabetes-related visits to dieticians and SMBG are associated with, and may be important sources of, improved diabetes knowledge in patients with type 2 diabetes. 2. Problems: Our data provide evidence that barriers to access or utilization of contemporary diabetes education confront older patients, minority groups and those with language difficulties 3. Adequate knowledge of diabetes is a key component of diabetes care (Beaser, Richardson, & Hollerworth, 1994). The potential benefits of diabetes knowledge include a sense of empowerment and improved quality of life (Beaser et al., 1994; Brown, 1990; Padgett, Mumford, Hynes, & Carter, 1988). While it has been difficult to demonstrate that formal diabetes education per se leads to improved metabolic control (Lockington, Meadows, & Wise, 1984), it is clear that improvements in outcomes cannot occur without adequate instruction about diabetes (Beaser et al., 1994). To this end, all people with diabetes are encouraged by the American Diabetes Association to attend formal diabetes education programs (Department of Health and Human Services, 1991). 4. Information about diabetes is obtained from a variety of sources including one-to-one interactions with doctors, nurses and dieticians. Self-monitoring of blood glucose

(SMBG) requires considerable instruction and could be an important additional source of diabetes knowledge for many patients. The value of SMBG in patients with type 2 DMwho are not on insulin treatment has been questioned because of doubts about beneficial effects on glycemic control (Evans et al., 1999; Faas, Schellevis, & Van Eijk, 1997; Kennedy, 2001) 5. instruction was associated with the highest knowledge scores. Where patients had been exposed to only two of these activities, diabetes education provided a more important contribution to knowledge than SMBG or dietetic advice 6. Alternatively, those who attend programs already have the qualities of adherence that are helpful in improving their self-management behaviors. Many studies have found little or no relationship between knowledge and behavior (Beaser et al., 1994; Lockington et al., 1984), while it has been repeatedly demonstrated that diabetes education programs lead to gains in diabetes knowledge (Brown, 1990; Karlander & Kindstedt, 1983; Padgett et al.,1988) as reflected by the present data.
Diabetes

7. The experience of living with insulin-dependent diabetes:lessons for the diabetes educator Hernandez, C.A., 1995

8. The Scope of Practice of Diabetes Educators in a Metropolitan Area

Mariorie Cypress, Judith Wylie-Rosett, Samuel S. Engel and Terry B. Stager,1992 Other health care professionals as diabetes educator.

The responses of the registered nurse and registered dietitian respondents, contribute to the most as diabetic education.more than 75% of the nurses performed 5 of the educator roles