Eoghan O'Brien, owner of Bannside Pharmacy in Portglenone, Co Antrim, talks to Saša Janković about setting up a diabetes control and reversal programme.
Service type: Portglenone Diabetes Partnership.
Name and location of pharmacy: Bannside Pharmacy Ltd, Portglenone, Co Antrim.
Name of pharmacist: Eoghan O’Brien.
Why did you start offering this service?
I started offering this service in 2018. At the end of 2017, Diabetes UK set up the Diabetes Innovation & Improvement Fund in conjunction with the Public Health Agency and the Department of Health. I thought it would be an idea to use this to run a 12-week lifestyle programme for 10 people with type 2 diabetes to see what health improvements would result.
How much did it cost to set up the service?
I bought an Alere 2 HbA1c analyser, which cost over £2,000, as I wanted to be able to measure and record outcomes. Test cartridges are around £6 each (£18 for three tests per person). In the second year (2019) I gave the participants a Freestyle Libre CGM sensor for a month at a cost of £70 each. Other than that, it is very time consuming with the four group sessions and seven one-to-one sessions, and I cost this in at £300 per person.
What, if any, training did you or other team members have to undergo?
I had been involved in a few fitness and weight loss programmes run by our local community and have always been interested in nutrition. My daughter was diagnosed with type 1 diabetes in January 2018 and that is the best training anyone could have on how carbohydrates affect blood glucose!
I completed the NICPLD/CPPE 16-hour training module Evidence Based Management of Diabetes, which I would recommend. As the programme involves carbohydrate reduction there is a hypo risk with patients on insulin or insulin secretagogues (such as gliclazide) so it is essential to know how to manage this, so I also completed a 1-hour module on the ‘Low Carb’ approach.
In January this year, I enrolled in a Health Coach Diploma with the College of Naturopathic Medicine, which will give me a formal qualification in developing my coaching skills further for optimal outcomes and will take around 10 months to complete.
In a nutshell, what does the service involve?
Our group of 10 people meet for 12 weeks, with four two-hour group sessions and seven one-to-one sessions, with a follow up at 18 and 24 weeks. The aim is for better control and/or reversal of type 2 diabetes by being willing to make changes in what they eat and drink, their physical activity levels, and how they manage their stress.
By 12 weeks we want to achieve at least one of the following:
- A clinically significant decrease in HBA1c of at least 0.5% - ideally down to 6.5% (48 mmol/mol) or lower
- A 5% decrease in weight and/or waist measurement
- An improvement in fitness levels
- A reduction in the required dose of medicines required for hyperglycaemia as determined by the person’s diabetic nurse or GP
- And an improvement in a validated measure of psychological health.
Roughly how often each month do you carry out the service?
I have run it twice (2018 and 2019) – once a year for 12 weeks with a follow up at 18 and 24 weeks. The 2020 program was postponed but I would like to go again in 2021 depending on how Covid restrictions pan out.
How much do you charge for the service?
I received additional funding from the Health and Social Care Board both years and from the Big Lottery Community Fund in 2019, so subsequently I was able to offer the service free of charge.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
Although the focus is primarily on changing to more healthy eating and more physical activity, some of the participants may benefit from dietary supplements that can help stabilise blood sugars, manage stress and help optimise energy
Roughly how much a month do you make from offering the service?
I receive £3,000 in total to cover the time to run the programme over 24 weeks.
How have patients responded to the service?
Fantastically! In 2018, 6 out of 10 patients had a reduction in HBA1c to 6.5% (48 mmol/mol) or lower, and 7 out of 10 reduced by at least 0.5% mmol/L. Two went into partial remission, and two reduced their medication (one had been ready to start insulin – HbA1c from 65 to 43).
In 2019, at 24 weeks, 5 out of 10 had a reduction in HBA1c to 6.5% (48 mmol/mol) or lower, 5 out of 10 had a reduction by at least 0.5% mmol/L, 7 out of 10 had a reduction in weight by between 3.3 and 7.8% (3 > 5%), and four reduced their medication.
In addition, two patients who had no change in 2019 came into the pharmacy last week and both had lost 2 stone in weight. One said her blood glucose levels were well down and she was looking forward to seeing her diabetic nurse. Both said something had recently clicked with them and they were able to apply what they had learned in the programme.
Would you recommend offering this service to other contractors?
Yes. I would love to see it as an enhanced pharmacy service and my vision is to help set this up when I have tweaked, streamlined and simplified it sufficiently.
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