Presentation on Type 2 Diabetes Mellitus

A pharmaceutical Case presentation on type 2 diabetes mellitus

1. S/No Name Mat. No. 1. ADAGBON Favour Ewere (Miss) PHA1700001 2. AZUBUIKE Chukwunenye Christopher PHA1808349 3. BASSEY Blessing Adiah (Mrs) PHA1808350 4. BENSON Emmanuella Akpevwe (Miss) PHA1700013 5. CHUKWUMA Naomi Onyeka (Miss) PHA1808352 6. CLEMENT-IROH Chukwuemeke Divine PHA1808353 7. CLEM-OGUAH Christian PHA1808354 8. EBESUNUN Eshiohe Gift (Miss) PHA1700174 9. ODEBODE Benedict Adeolu PHA1700043 10. SAMUEL Oshiokenoya Martha (Miss) PHA1700069 11. UGWUOKE Rachael Nneoma (Miss) PHA1808467 12. UKEGHE Oghenetega Divine PHA1808468 13. UMEOZULU Tochukwu Basil PHA1808469 14. UWAGBOE Vbenaye Success (Miss) PHA1808472 15. VAREBA Pius Meedubari PHA1808473 Group 11 pharmaceutical care for type ii diabetes

2. Demographics Outline Care Plan Data Collection Assessment Conclusion Introduction 01 02 03 04 05 i . Title ii. Demographics iii. Chief Complaint vi. Lab Investigation iv. History of illness vii Diagnosis v. Social and other pertinent history viii. Evaluation of Therapy ix. Drug Therapy Problems xiii. References x. Goals of therapy xi. Outcome xii. Documentation S/No Name Mat. No. 1. ADAGBON Favour Ewere (Miss) PHA1700001 2. AZUBUIKE Chukwunenye Christopher PHA1808349 3. BASSEY Blessing Adiah (Mrs) PHA1808350 4. BENSON Emmanuella Akpevwe (Miss) PHA1700013 5. CHUKWUMA Naomi Onyeka (Miss) PHA1808352 6. CLEMENT-IROH Chukwuemeke Divine PHA1808353 7. CLEM-OGUAH Christian PHA1808354 8. EBESUNUN Eshiohe Gift (Miss) PHA1700174 9. ODEBODE Benedict Adeolu PHA1700043 10. SAMUEL Oshiokenoya Martha (Miss) PHA1700069 11. UGWUOKE Rachael Nneoma (Miss) PHA1808467 12. UKEGHE Oghenetega Divine PHA1808468 13. UMEOZULU Tochukwu Basil PHA1808469 14. UWAGBOE Vbenaye Success (Miss) PHA1808472 15. VAREBA Pius Meedubari PHA1808473

3. 01 Introduction

4. 01 Demographics Mr. FAC is a 46yrs old poultry farmer who lives in Benin City. He is a Christian, married with a child. He weighs 70kg (height: 159cm) Vital signs on arrival to hospital: 20c/m 80beats/min 113/78mmHg 36°C 162mg/dl 27.69kg/m 2 RR HR BP T FBS BMI Demographics Outline Care Plan Data Collection Assessment Conclusion Introduction 01 02 03 04 05 i . Title ii. Demographics iii. Chief Complaint vi. Lab Investigation iv. History of illness vii Diagnosis v. Social and other pertinent history viii. Evaluation of Therapy ix. Drug Therapy Problems xiii. References x. Goals of therapy xi. Outcome xii. Documentation

5. Chief Complaint and other presenting symptoms 01 Poor vision High blood glucose 03 Generalised body weakness Polydipsia Polyuria Polyphagia 02 04 02

6. History of Present Illness Patient FAC is a known diabetic patient with type II diabetes mellitus 01 02 03 Patient had extremely high glucose level with attendant symptoms which prompted hospital visit. He was stabilized and discharged with take-home medications with instructions to return for a checkup in 2 weeks at which point we interacted with him. He had been on oral hypoglycemics for years but has been known to be inconsistent with his therapy. However, patient has also requested for herbal remedies. 02

7. Social History and other pertinent History Patient is married with one child (F) No history of drug allergies No history of food allergies Does not smoke or drink alcohol Patient takes soda occasionally Social history Family History 02 Patient had a father who was diabetic

8. Lab Investigations Past Medication History Diagnosis 02 Lab Investigation Test Request Result Result Result Reference Value 1. Fasting blood glucose 162mg/dL 70-126mg/dL 1 2. Random blood glucose 330mg/dL <200mg/dL 1 Past Medication History Prescribed Drugs Non-Prescription drugs Name/strength/form Dosage regimen Purpose Side effects/ problems Outcome Nil Metformin tablet 1g Twice daily for 1 month Hyperglycemia Nil Controlled hyperglycemia Glibenclamide tablet 5mg Once daily for 1 month Hyperglycemia Nil Controlled hyperglycemia Insulin IM / IV 10IU stat Every 2 hours Hyperglycemia Nil Controlled hyperglycemia Normal saline 1 litre 1 - 2 hours Hyperglycemia Nil Controlled hyperglycemia Diagnosis Type II Diabetes Mellitus

9. Present medication 02 Prescribed Drugs Name/strength/form Dosage regimen Purpose Side effects Outcome Metformin tablet 1g Twice daily for 2 weeks Hyperglycemia Nil Uncontrolled blood glucose Glibenclamide tablet 5mg Once daily for 2 weeks Hyperglycemia Nil Alphabetic plus tablet Once daily for 2 weeks For wellness Nil

10. Evaluation of Therapy 03 S/N Prescribed Drugs Prescribed daily dose Minimum daily dose Maximum daily dose Appropriate? 1 Metformin 1000mg bd 2000mg 500mg 1 2550mg 1 Yes 2 Glibenclamide 5mg od 5mg 2.5mg 1 20mg 1 Yes 3 Alphabetic plus tablet 1 tab - - Yes

11. Drug Therapy Problems 03 S/No Drug Therapy Problems (DTPs) Actual DTP Potential DTP 1 Unnecessary Drug Therapy 2 Dosage Too Low 3 Need for Additional Drug Therapy Yes 4 Dosage Too High 5 Adverse Drug Reaction 6 Inappropriate Compliance Yes 7 Ineffective Drug Yes

12. Drug Therapy Problems 03 DTPs DTPs Details (Causes) Need for additional drug therapy The metformin 1g bd and glibenclamide 5mg od he was placed on for the past 2 weeks for hyperglycemia only maintained patient’s blood glucose levels at around 162mg/dL, hence the need for another drug Ineffective drug Therapy was not effective at lowering blood glucose levels Inappropriate compliance Patient did not adhere to medication in the past possibly due to preference for herbal medicine. Hence, he is likely to continue the already formed habit of non-adherence

13. Goals of Therapy 04 01 02 03 Education of patient on his condition and need for adherence Reduce FBS from 162mg/dL to <126mg/dL in 2 weeks Prevent complications such as microvascular complications, diabetic foot ulcer. Reduce BMI value from 27.69kg/m 2 to <24.50kg/m 2 Reduce hospital admission and visits Dietary and lifestyle modifications 04 05 06

14. Care Plan / Interventions 04 01 02 03 Prescriber was contacted in writing to c hange glibenclamide 5mg od to vildagliptin 50mg bd in a combination therapy with metformin 1g bd. Patient was educated on the chronic nature of his condition, need for active lifestyle, exercise, eating balanced diet in 5 to 6 portions per day, reduce soda intake and the need for adherence to therapy to prevent complications. Patient was educated on appropriate self-monitoring of blood-glucose using a glucometer and regular monitoring for complications 04 Referral to an ophthalmologist for eye checkup due to suspected retinopathy 05 Discouraged patient from use of herbal medication through education

15. Outcome 04 Increased productivity due to reduced sick time Reduced hospitalization and visits to the physician Economic Clinical Symptom control was achieved Glycemic control achieved with FBG = 113mg/dL Adherence was achieved on drug and non-drug therapy BMI (currently at 26.82 kg/m 2 ) is yet to be reduced to <24.50 kg/m 2 Improved patient knowledge of t2DM and its mgt. Patient attitude to illness was improved Patient was satisfied with thera py Humanistic

16. Follow Up 04 Patient was contacted everyday for the first week and on alternate days in the second week to ensure that he is following both the drug and exercise regimen and also following the dietary modifications recommended. Patient was also encouraged during the call to check his FBG and RBG values, and document properly prior to his next visit, which was in two weeks’ time.

17. Documentation 04 The drug therapy problems identified were added to the patient’s record file along with his medical condition, the interventions and the outcome during follow-up and monitoring. Nigeria Standard Treatment Guideline 2 nd Edition 2016 Essentials of Pharmaceutical care 1 st edition by Prof. Azukah Oparah Medscape journal of medicine Outpatient Pharmacy Department, Faith Mediplex Hospital.

18. References Nigeria Standard Treatment Guideline 2 nd Edition 2016 Essentials of Pharmaceutical care 1 st edition by Prof. Azukah Oparah Medscape journal of medicine Outpatient Pharmacy Department, Faith Mediplex Hospital. Documentation The drug therapy problems identified were added to the patient’s record file along with his medical condition, the interventions and the outcome during follow-up and monitoring.

19. Thank You for listening