IN BRIEF Most diabetic patients are managed by primary care physicians, but clinical inertia and limited time with patients hamper efforts to meet treatment goals. Successfully caring for the medical and psychosocial needs of the expanding diabetic population seen in primary care will require new strategies. This article reviews interdisciplinary efforts by primary care physicians, advanced practice nurses, and clinical pharmacists that can achieve improvements in clinical processes and outcomes at reasonable costs.

Type 2 diabetes mellitus has been associated with an increased risk of hepatic, pancreatic, colon, endometrial, breast, and bladder cancer. Although a mechanism of action for the increased risk has been postulated, no definitive evidence has been completely elucidated in the medical literature. Results of recently released studies documented the use of specific antidiabetic drugs with increased rates of cancer. The insulin analog glargine was the focus of four observational studies published in 2009 that outlined an increase in the rates of cancer associated with its use. In contrast, the use of metformin has been shown to possibly decrease the rate of specific cancers when used in the treatment of type 2 diabetes. These data regarding cancer risk and antidiabetic drugs are contradictory and at this time are inconclusive. Until results of long-term randomized prospective studies are available to elucidate a correlation with cancer and insulin, we must continue treating diabetes in order to avert the long-term complications of the disease.

Six months of pharmacist intervention resulted in improvement in patients achieving ADA and VA performance measure goals individually and in combination.