Diabetes Medication Therapy Adherence Clinic

Bismillah...

Diabetes Medication Therapy Adherence Clinic a.k.a DMTAC.

What is DMTAC? It's an ambulatory service which emphasize on medication management. This service is handled by pharmacist who provide counseling and education to patients with the purpose of helping them manage their condition and prevent debilitating symptoms. Shortly, we, pharmacist wants patient to get to know their disease well and consume their medications as directed.

It's a service available in most of the government clinics and hospitals in Malaysia.

So, last week I was attached in HPJ for a week to improve my knowledge and learn DMTAC held there. It was a stressful week. Shortly, this is how my week started and ended. 

• On Monday there was a short briefing on DMTAC, pre-test and the week's timetable. In the afternoon we had to clerk lots of ward cases from FiCiSen *I hope I spelled it right* in a CP2 form. 
• My friend and I went for ward round on Tuesday and Wednesday morning. On Tuesday afternoon, I did 3 counselling and 1 discharge meds. 
• On Wednesday afternoon we searched for possible DMTAC new patients based on patients' previous HbA1c. 
• On Thursday morning we counselled new and old DMTAC patient in the DMTAC clinic.In the afternoon we did a presentation on the cases chosen individually. *It was my worst presentation in my life* SO SAD... 
• On Friday, we completed up our CP2 forms to be collected by the preceptors. That afternoon we did our post test and discussed the answers.

If I could reverse time, before going for the attachment, I would have:

• Read a handful of everything about diabetes, the treatment, the complications, types of meds and its side effects, DKA, HSS, BIDS treatment
• I'd follow my friend, clerking only 5 cases instead of 10 cases
• I'd focus on my slides instead of worrying about the presentation
• Pick a really good diabetes case for my presentation even if it's from the other ward instead of presenting a case with lots if PCI

Despite the stressful week, I did learn a lot. I learnt a value lesson. Sometimes, we shouldn't follow the rules on paper. We have to let loose base on the situation.

Live life to the fullest; the fun way.

Wassalam & Cheers.

Health is Gold

Bismillah...

Today I'm going to do a summary of what I learnt during the 2 days conference last weekend. It was an Ambulatory Care HKL Pharmacy Conference. So, here are the facts and figure:

• Medication Therapy Adherence Clinic (MTAC) is also known as Medication Therapy Management (MTM) in USA
• Diabetes in Malaysia 2011: has increase to 20.8% from 14.9% previously.
• 1 of 5 adult Malaysians above 30 years old have diabetes. 
• 366 million people with diabetes in year 2011.
• 28% Asians with uncontrolled type 2 diabetes (HbA1c >7%) on OAD & insulin therapy.
• 9.9% world population expected to have diabetes in 2030.
• 130 billion USD spent on diabetes in European region in 2011.
• 44% American with diabetes not at HbA1c target.
• 22% Malaysian with diabetes reaxhed HbA1c target.
• A1c = fasting glucose + postprandial glucose.
• Higher than 10 A1c, preblem is fasting plasma glucose.
• Lower than 10 A1c problem is post prandial glucose.
• A reduction of 1% HbA1c may reduce 37% of macrovascular complication in diabetes patient.
• Immediate use of insulin may improve glycemic control and lower risk of complications.
• Hypoglycemia in diabetes patients can cause heart attack.
• Insulin is meal related.
• Incretin is an intestine secretion insulin (gut derived factor).
• Pancrease; alpha cells reduces hepatic glucose production & beta cells: increase glucose uptake by peripheral tissue.
• Alpha blocker may cause postural hypotension.
• Aspirin can be given as a stroke preventive medication.
• 50% of kidney damage for the creatinine level to rise.
• Tighter Blood Pressure control is more important compared to glycemic control to reduce mortality (death).
• Hypertension treatment reduces cardiovascular events in diabetes.
• Diabetic BP: less than 130/80
• Poor BP control may lead to TIA & stroke.
• Q10 reduces muscle cramps.
• To start anticoagulation meds, use CHADS risk criteria; higher CHADS score, higher chance of stroke.
• Bleeding comparison; warfarin is better than aspirin.
• For asthma treatment, Step down if 3 months without attack; well controlled.
• COPD classification uses CAT (COPD assessment test) score.

An apple a day keeps the doctor away.
Take care of your health as it is very precious for oneself.

Wassalam & Cheers.