Business Proposal Diabetes

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                 Diabetes Education Committee
                         Tina K. LePhar.
                       Joane A. Mar Phar.
                         Lin P. Ta Phar.




             Diabetes Awareness Proe:ram
Walgreens ' Diabetes Education Commttee
5420 NE 33rd Avenue
Portland , Oregon 97211


Karin Hughs, RPh.
Pharmacy District Supervisor
Walgreens Corporate Offce
7700 NE Ambassador Place Suite 103
Portland, Oregon 97220
(971) 203- 0555

June 1 ,   2004

Dear Ms Hughs:

We have developed a business strategy designed to increase Rx sales via diabetes
education programs conducted by Walgreen s pharacists and would like to propose a
demonstration project for your consideration. The proposed program includes a series of             11 /L
educational programs regarding medication use, diet and monitoring to be conducted in
cooperation with the Afcan- American Health Coalition of Portland. Preliminar talks
with their leadership over the past few weeks have been fritful and they are interested
pursuing this idea.

We feel that Walgreens and the Afican- American Health Coalition of Portland wil both
benefit ftom this pilot project. Sales of diabetic related products and prescriptions should
increase in Walgreen s stores located in target market areas and patient health status will
improve due to better monitoring and patient care. We have developed patient
questionnaires to evaluate the program and same store sales can be recorded by existing
Walgreens ' accounting reports.

Thank you for your time. Please feel ftee to contact Tina Le at (503) 493- 2715 store
#06140. We hope to be hearng ftom you soon for a presentation at your convenience.

Sincerely,
                                                                                            '?D r




Tina Le     Phar.
                                                                                      I\T
                                                                                                    k- W'




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                                                                                 Table of Contents

1. 0 Executive Summar
                  1. Description of Walgreens ' Diabetes Education Committee...........................
                  2. Corporate Mission
              1.3. Sumar ofWDEC                                                             Proposed Pilot Progrmn..................................................................


 0 Summar of Committee
                   1. Committee Owership ..........................................................................................................................................
                  2. Committee History...........................................................................................................................................................
                  3. Committee Service.........................................................................................................................................................
                  4. Committee Location and F acilities....................................................................................................


 0 Business Proposal
                   1. Description ofWDEC Pilot Program.........................................................................................
                  2. Service Niche.........................................................................................................................................

                  3. Supporting Literature ................................................................................................................................




                  6. Futue Servce
                  4. Service Outsourcing"..................................................................................................................................

                   5. T echnology..........................................................................................................................................................................

                                                                        ......................................................................................................................................................-..............n.",,""'"''



 0 Marketing
                   1. Industry Analysis
                             11. Industry Paricipants ..........................................................-........................................-....................
                              12. Market Segmentation.............................................................................................................................
                              13. Promotion Options............................................................................................................................ .1 2
                              14. Main Forecast .............................................................................................................................................. .1 3
                   2. Marketing Strategy
                              11. Action PlaQ...................................................................................................................................                                                                J4
                              12. Target Markets                                                                                                                                                                                                .. 5
                              13. Promotion                                     Strategy....................................................................................................................................



              4.4. Servce and Support
                   3. Strategic Alliances


                   5. Timeline ........................................
                                                                                                                                                                                                                                                  J6

                                                                                                                                                                                                                                                   i8

 0 Price            List................................................................................................................................................................................................................



 0 Financial Statements......................................................................................................................................................................


Appendix A: Organzation                                                    Char
Appendix B: Resumes
Appendix C: Forms
             Coupon
             Sample flyer
             Program Evaluation
             Brown Bags Medication form
Supplemental: Presentation Slides and Brown Bags Service Description
             Diabetes & Children
             Diabetic Medication
             Diabetes: Nutrtion & Exercise
          . Afcan-American and Diabetes-Related Complications
             Gestational Diabetes
              Special Optional Service: Brown Bags
  0 Executive Summary

1.1        Description ofWaigreens ' Diabetes Education Committee

Walgreens ' Diabetes Education Commttee (WEC) is a group of diabetes trained

pharmacists who plan and facilitate diabetes educational events in various community

locations. Our focus is to raise diabetes awareness in the Afcan-American community

at risk for diabetes in North Portland.           5 A          lc (        Lv




The committee currently consists of three pharacists    from   three different Walgreens

stores. Committee meetings take place at the Portland corporate offce located at 7700

NE Ambassador Place Suite # 103 , Portland , Oregon 97220.      Ou contact information is
Walgreens ' Diabetes Education Committee
Walgreens Store #06140
Phone: (503) 493-2715
Email: diabetes. ed. oregon walgreens. com

1.2         Corporate Mission

Our mission is to offer diabetic testing, educational seminars, personal health

consultation and promoting Walgreens ' goal in its mission to improve standard of patient

care.

            Summary of WDEC Proposed Pilot Program

Walgreens ' Diabetes Education Commttee plans and facilitates a community diabetes

educational seminar every two weeks in the North Portland area. These events are in

parnership with the Afcan- American Health Coalition and will be hosted at varous                        fr'\
locations such as Legacy Hospital and Providence Hospital.       Three pharacists wil


staf each event and present discussions related   to diabetes and basic screening exams.

The number of paricipants ftom the seminars who visit Walgreens wil             be tracked over a


three-month period (or six consecutive seminars) to access the impact of these diabetes                  -vJ
                                                                                                    fU



educational seminars.                                                               ) t.

                                                                      'J




                                                                           wl      plt.
 0 Summary of Committee

  1 Committee Ownership

Walgreen s Diabetes Education Commttee consists of three specialty trained diabetes

pharacists:

Tina Le , PharmD.

            Phar.
Joanne Marin,


Linh Ta, Phar.

  2 Committee History

We are currently Walgreens ' employed pharmacists who are trained in diabetes care and

have an extensive knowledge and expertise in diabetes medications and devices. As

diabetes educators, we have developed a plan to promote Walgreens pharmacy to the

public at risk for diabetes.

  3 Committee Service

Walgreens Diabetes Education Committee works to raise public awareness of Walgreen

pharmacies in the neighborhood that can provide specialized diabetic servces through

community outreach programs. Community programs include diabetes screening,

education on risks of diabetes, diabetes life styles, coping with diabetes, healthy recipes

current updates on diabetic medications , and devices. Presentations on these subjects are

enclosed in the Supplemental.

  4 Committee Location and Facilties

Committee meetings take place twce     a month   at the Portland Walgreens Corporate offce

located at 7700 NE Ambassador Place Suite #103 , Portland , Oregon 97220. All meetings

are open to interested Walgreens pharacists.     Our   contact information is provided in our

description section. All planned community events take place at varous locations in the
North Portland area. Location of events wil be       determned upon availability from a list

of sites provided by Afcan- American Health Coalition.

  0 Business Proposal

  1 Description ofWDEC Pilot Program

The services that WDEC provides to the public include community-based educational \

seminars on varous diabetes-related    topics ,   brown bag events, glucose screening, blood    j)OO




pressure measuring and complimentar lunch at each event. By outreaching to the                  uJ
community, we expect an increased awareness ofWalgreens and the services it provides

Therefore , the population using Walgreens pharacies         wil increase. Store #07119 on
    and Killngsworth, North Portland has a sub-optimal average number of prescriPtion                  Il-   \;, '1



filled per day. One of the goals of WDEC' s proposed program is to increase the averagi

number of prescriptions at store #07119.

  2 Service Niche

Currently, there are no similar programs implemented in the North Portland areas to

increase diabetes awareness and to meet the local population needs in diabetes care. The

WDEC foresees a need to focus on the Afcan- American community in this region due

to increasing percentage of the untreated diabetics and the number of people at risk in this

population. In 2002 , Afican- Americans comprise 6. 79% of the Multnomah County

population. Research shows that Afcan-Americans are 1. 6 times more at risk of

becoming diabetic versus Non-Hispanic Whtes for varous reasons.

  3 Supporting Literature


American Diabetes Association. Economic costs of diabetes in the U. S. in 2002.      Diabetes
Care. 2003;26:917- 932.

Campbell RK. Role of the pharacist in diabetes management.           Am J Health-Syst Pharm.
2002;59S:S18- 21.
Cox RH Carenter JP , Bruce FA, Poole KP , Gaylord CK. Characteristics of low-income
Afican-American and Caucasian adults that are important in self-management of tye 2
diabetes.   J Community Health.   2004;29: 155- 170.

Raji A, Gomes H, Beard JO , MacDonald P , Conlin R. A randomized trial comparng
intensive and passive education in patients with diabetes melltus. Arch Intern Med
2002; 162: 13 0 1- 1304.

Satterfeld DW, Volansky M, Caspersen CJ , Engelgau MM, Bowman BA, et al.
Community-based lifestyle interventions to prevent tye 2 diabetes. Diabetes Care.
2003;26:2643-2652.

    4 Service Outsourcing

Complimentar lunch for the attendees wil      be provided by Elephant      Delicatessen. A

discounted price is contracted at $9. 00 for each white box lunch. Beverages wil be

provided by Walgreens store # 07119. Afican- American Health Coalition wil             reserve


and set up event locations. Print materials will be serviced by Kinko store on 2008 NE

Grand Ave, Portland. Walgreens wil       provide glucometers ,   strips , lancets , alcohol pads

cotton balls, bandages , and biohazard waste containers.

     5 Technology

Walgreens Corporate Offce wil purchase laptops, projector and screen, stethoscopes and

sphygmomanometers.

     6 Future Services


WDEC wil implement Walgreens s Diabetes Awareness Program in the North Portland

area for three months before the commttee perform statistic analysis to determne impact

of our pilot program. Success of this project will inspire the Diabetes Education

Committee to implement our program to other regions where new Walgreens stores show

suboptimal prescription averages. Depending on the health needs of one paricular area

WDEC will develop appropriate disease educational seminars such as asthma,
hypertension, cardiac diseases,   hypercholesterolemia ,   women s health, or

osteoporosis/arhrtis.

  0 Marketing

  11 Industry Participants


Our research found a number of events held by different organations to increase

diabetes awareness and support in the Portland area. Events that focus on and outreach to

the Afican- American population in the North Portland area are limited in number and

educational values. Unlike the Walgreens ' Diabetes Awareness Program, which

incorporates updated educational information and health care servces , most of these

programs focus on group support and activities. The Diabetes Screening and Service

Linkage program by Afcan- American Health Coalition is an example of a program most

similar to the Walgreens ' Diabetes Awareness Program. However , the wealth of

information provided by our program is more in depth and involved more expertise.

Curently, Safeway sponsors the anual Portland Diabetes         Expo held by the American

Diabetes Association at the Portland Convention Center. No other chain pharacies are

 known to promote or run similar events to the WDEC proposed pilot program in the

North Portland area. Some unique benefits that the Walgreens ' Diabetes Awareness

 Program offers compared to other programs are listed below:

     . We offer various diabetes-related topics in consecutive educational seminars

        Selected topics cover everyhing the community needs to know about diabetes

        The information presented is more relevant, focused and up-to- date ITom specialty

        trained pharacists

         Attendees may choose to have their blood pressure checked , glucose level tested

         or questions answered at each event
       Special Brown Bag events provide attendees with comprehensive evaluation of

      their current medication therapy

       Paricipants are provided with up- to- date   information on diabetes related

       activities , events, support groups and camps in the area

 12 Market Segmentation

Walgreens ' Diabetes Awareness Program targets Afican- Americans living in the North

Portland , District 2 ofMultnomah County (figure 1). A carography obtained ftom the

Multnomah County Geographic Inormation          Systems   show a high density of Afcan-

Americans living in District 2 based on 2000 US Census data (figure 2 3). This

population was chosen based on their higher risk of contracting diabetes melltus when

compared to other ethnc/racial backgrounds living in the same district.




     Figure 1
                      Multnomah County, Oregon
                       Commissioner District
                                 County Commissioners
                                      Disbict I---Maria Rojo de Steffey
                                      Distrct 2--- Serena Cruz
                                 II Distrct 4---lonnie Roberts
                                      Distrct 3- Lisa Naito




                        htt://ww. co. multnomaor. usdbslit/mapslprojeccommsh/
                                    2001 -   Commssioner - Distcts. shtm
                                    ' .




                                                                       The desit i$ caculated by cfNiding the Single Race
                                                                       Black poulation by the to poation for a block.




Figure 2




      ( No People
    Deit of Blacks in Blocks
           None
                        9%
               9%
             1% to 4.
           5% to 9. 9%
     . 10%1024.
           25%10100% . .
                         5.




                  ht://ww. co. multnomaor. usdbslitlmapslprojectsldemogrphicslmasllack.pd
                                                                      Number of BlacJs in Tract
                                                                              249
                                                                           250 - 499
                                                                           500 - 999
                                                                           1000 - 2189




   Figure 3




                              htt://ww. co. multnoma. or. usdbslitlmapslprojecdemogrphics/masllack. pd


   In 2002 ,      18.   2 millon people in the United States have diabetes , about 6.3 percent ofthe

   population. 13 millon people have been diagnosed and about 5. 2                       millon undiagnosed


   people have diabetes. By ethnc/racial background among people aged 20 years or older

   the National Institute of Diabetes & Digestive & Kidney Disease of the National Institute

   of Health (NDK) found the following total prevalence of diabetes in table 1 ,                                and figure /
               Table 1.   NIDK Total Prevalence of Diabetes by Race/Ethnicity, 20
                                    years or 0   ld U DIte d
                                                  er,              a t2002
                                                                  St es
Non-Hispanic    Whites:                     12. 5   millon     8.4 % of
                                                               non-Hispanic whites
Non-Hispanic Blacks:                          7 millon         11.4 % of
                                                               non-Hispanic blacks
Hispanic/atno Amecans:                        0 million          2 % of
                                                               HisvaniclLatinos
Amercan Indians, Alaska Natves:              110 814            14. 9% of
                                                                American Indians/Alaska Natives
                                                                Native Hawaian, Japaese , Filpino
Asian Amecans, Native Hawaiian               lited data
                                                                residents of Hawai: 2 ties liely to get
other Pacifc Islande:                                           diabetes compared to white residents
                                              889 186



  Figure 4             Age-adjusted total prevalence of diabetes in people
                        aged 20 years or older. by racelethcity-United
                                           States, 2002

                American IndiansAlas Natives


                      Hlspanlo'LaUoo Americans


                            Non-Hispanic Maw


                            Non Hlspanic whtes

                                                                  10
                                                                   Percet
             SOU: 199201 Nalonlkal1h Intccw Suey, 19.20     Na1(Joa Health an Nuttion Examoaon
             Sww c5tma prjeckd to) 200, ..If lO ouai dab-   of the Indan Beat. Screc.

     Graph obtaed from Nationa Diabtes Inormtion Cleaghouse. Nationa                    diabetes sttistcs.

                               Nl
                                publication No. 04-3892 , Apri 2004


 Figure 5          Prevalence of Diabetes Amongst Race/Ethnic Background
                                       20 years and older, 2002


                                                                          8 Non- Hispanic   Whits

                                                                          8 Non- Hispanic   Black

                                                                          o Hispaniclauno

                                                                          OAmerican Indians/Alask Naties

                                                                          8Asian Americanslative HawaiianIaciic
                                                                            Islanders
       NlDK data demonstrates the Afican- American population with 1. 6 times the chance of
       becoming diabetic verses Non-Hispanic Whtes. Values comparing between Non-

       Hispanc Blacks and American Indians/Alaska Natives may be misleading due to the vast

       difference between their population size in the United States even though there is a higher

       percentage of the American Indians/Alaska Native diagnosed with diabetes.

       Using NlDK percent population figures and percentages to calculate Oregon and

       Multnomah County, we estimated the following prevalence of diabetes in 2002 with

       values found in the U. S Census Bureau s American Community Survey, table 2 3 and

       figure 6.


       Table 2. Oregon Estimated Extrapolated Data of Diabetes Prevalence, 2002
                                              Survey       Percent with      Estimated
                                                  Estimated           diabetes        diabetes
                                                   Values                            population
                                                                     Values from
                                                                       NIDK
       Oregon Total Populaton:                          444 153                           216 982

       Non-Hispanic    Whites:                          086 887        8.4%               259 299

       Non-Hispanic    Blacks:                              938        11.4 %                  657

       Hispanic/atno Amecans:                           306 244                                112

       Amecan Indians, Alaska Natves:                       376        14.                     764

       Asian Amercans, Natve Hawaiian                   156 007       unvaile
        other Pacifc Islande:




"1'-
     Table 3. Multnomah County Estimated Extrapolated Data of Diabetes Prevalence,
     2002
                                                           Percent                         Survey                 Percent               Estimated
                                                           Population                     Estimated                 with                 diabetes
                                                                                              Values              diabetes              population
                                                                                                                 Values from
                                                                                                                   NIDK
 Multnomah County                                                                               660 938                                          640
  Total Populaton:
 Non-Hispanic         Whites:                                      83.                          551 948                8.4%                      364

 Non-Hispanic         Blacks:                                         79%                              931             11.4 %                    122

  Hispanic/atno Amecans:                                                                               557                                       720

  Amecan Indians, Alaska Natves:                                      24%                              782             14.                       203

  Asian Amercans, Natve Hawaiian                                      99%                              779        unvaible
  other Pacific Islandes:



        Figure 6. Estimated Diabetes Prevalence of Diabetes in Multnomah County, 2002

              000


              000


           40, 000


              000


           30, 000


Populallon 25 000


              000


              000


              000


              000



                     Non- Hispanic White   Non. Hispanlc   Black         H ispan ie/Latin 0          Am erican            Asian Americans
                                                                            American            Indian/Alaska Native    Native Hawaiian. other
                                                                                                                           Pacific Islanders
                                                                   Ethlnlc/Raclal Background
Data shows a higher probabilty of non-Hispanic whites with diabetes in the county. We

need to take into account the four districts ofMultnomah County and acknowledge that

district 2 (North/ortheast Portland) houses the highest population of Afican- Americans.

Figures 7            11 show population densities for each major ethnc/racial background in

Multnomah County. District 2 (NIN Portland) holds the highest density of Afcan-

Americans as seen in figure 7. This population is an excellent group to test WDEC'

pilot program because they are at high risk of contracting diabetes and is the highest

ethnic/racial background in that district.


                                                                          Number of Blacks in Tract
                                                                                     249
                                                                                250 - 499
                                                                                500- 999
                                                                                1000 - 2189




Figure 7.
Mrica-American
Population Density
in Multnomah
County, 2000

                      htp://ww. co. multomaor. usldbcslitmapslprojects/demographicslmasllack.pdf



                                                                       CUent City Bouoones
                                                                   Number of Whies in Tract
                                                                      99 - 1499
                                                                        150 - 2999
                                                                        300 - 4499
                                                                        450 - 6767

Figure 8.
Whte Population
Density in
Multnomah
County, 2000




                     htp://ww. co. multnomah.or.us/dbcslitmapslproject/demogrphicslmapslwhite.pdf
                                                                                                    p-

                                                                            Currnt Cit Boundaries
                                                                       Hispanics in Tract
                                                                                 249
                                                                            250 - 499
                                                                       - 500- 999
                                                                             1000 - 1707




Figure 9.
Hispanc
Population Density
in Multnomah
County, 2000

            htp://ww. co. multomaor.usldbcslitlmapslproject/demogrphicslmapslspanc.pdf
                                                                                                    ""I
                                                                                                          6785
                                                                                                          1.0%




            htp://ww. co. multomaor.usldbcslitmapslprojects/demogrphicslmapslamd.

                                                                        Current Cit Boundares
                                                                    Number of Asians in Tract
                                                                            249
                                                                        250 - 499
                                                                    - 5()- 749
                                                                    _750- 985

Figure 11.

Asian Population
Density in
Multnomah County,
 2000

            htp://ww. co. multomaor.usldbcslitmapslproject/demogrphicslmapslasianpdf

    13 Promotion Options

  WDEC contract with Afcan- Amercian Heath Coalition because they are a highly

  recogned        organzation dedicated to increase wellness               of the       Afican- American

  population in our targeted region.
Direct marketing of our services within the North Portland community include:

                 . Afican- American Health Coalition Website

                 . Afcan- American Health Coalition Newsletter

                    Advertisement in The Skaner, a weekly Afican- American publication and

                    the Oregonian

                    Distribution of brochures , flyers , and sign up sheets at the Afcan- American

                    Health Coalition Offce and other local Walgreens stores


  14 Main forecast

We expect to have 100 attendees at each educational seminar. Brochures and flyers wil

be available at the Afcan- American Health Coalition Center and at varous Walgreens

locations in the North Portland area. Paricipants wil need to sign up for each event at
                                                                                                          pV


wher sign up sheets ar          avlable. Registron can        also be done by phone: (503)         493-

2715 or e-mal:         diabees. ed. oregonl1walgrens. com . Th WDEC wil kee                  tr   oflb




number of people signing up for the events each day. Sign ups wil                     close once lOp
people have registered. Limiting the number of paricipants to 1 00 allows each

paricipant to have full access to event's additional servces.

At the entrance , each attendee will receive a handout of the presentation, a copy of

 Walgreens           Diabetes and You" newsmagazine and a $5 coupon to be redeemed at the

 Walgreens store #07119. A surey           was conducted      at three Walgreens stores in the North

 Portland community to estimate the percentage of people that would use the coupons or

 utilize the pharacy store #07119 afer          attending a   seminar with in a one-month period.

 Statistical analysis shows about 80% of the surveyed people would come to store #07119

 to either redeem their coupons or to visit the store. 60% of these people would make
purchases ITom the store to use their coupons and 50% of them would spend an average

of $20. 10% of those who visit the store would come in the pharacy to seek advice

ITom the pharacists or to fill their         prescriptions (figure 12).


The coupons wil have identical barcode and be scanned at the cashier s registers. The

number of coupons collected will be tracked ITom the barcode scanned into the system

every 2 weeks , and a report will be sent to the committee for evaluation and statistical

analysis. Based on statistics ITom our survey, we set a goal to increase the average

number of prescriptions filled at store #07119 ITom 100 to 150 prescriptions per day.


              Figure 12.                    Activity of People Visiting Walgreens




    Number of Visitors 40




                            80% of the People will   60% of the 80% will 50% of the 60% will   5% ofthe 80% peple
                               visit the store        make a purchase spend an average of      will use the pharmacy
                                                                                     $20
                                                               Activit of Visitors




  2 Marketing Strategy

  11 Action        Plan

Project plannng for a series of 6 three-hour consecutive seminars will take one month.

Each seminar wil be held two weeks apar. Pharacist and pharacist techncians                                who
are interested in volunteering for any events need to sign up two weeks before each event.

Advertising will take place two weeks prior to each event. Whte box lunches wil be

ordered ITom Elephant Delicatessen for paricipants.    Attendees wil    pay a registration fee

of $10 to compensate the cost of purchasing food and beverages. Presentation wil       last

for 45 minutes at each event followed by a 30- minute question and answer session.

WDEC will run two stations for glucose testing, and one for blood pressure checking.

Paricipants are encouraged to   utilize any station.


  12 Target Markets

The target market ofWDEC project is Afcan- Americans living in the North Portland

District 2 ofMultnomah County. Educational events wil primarly focus on the Afican-

American population because statistics show that this group is 1. 6 times more at risk of

diabetes when compared to Non-Hispanic       Whites. Our audience wil be 18 years     of age

or older because they can legally make decisions about their health and purchase of

products and/or services.
                                                                             \I -
                                                                                    p)v t(u           J"'J
  13 Promotion Strategy
WDEC members are health care professionals with experience and intensive training in

managing diabetes. We are commtted to giving the community our best services.

WDEC wil provide contact information of other Walgreens diabetes trained pharacists

in local stores. This program will have positive impact on paricipants about Walgreens

services especially in diabetes care. Patients are encouraged to come to Walgreens stores

for any health care related questions they have. The paricipants     wil be more familiar


with diabetes trained Walgreens pharacists      and seek   their services at our pharacies.

Pharmacy store #07119 has available varous demonstration glucometers for customers             to !
test out. This wil benefit our customers in makng purchases of their most suitable

glucometers.

  3 Strategic Alliances

The WDEC contracts with the Afcan- American Health Coalition to facilitate different

event locations in the North Portland region. The Afican- American Health Coalition is a

non-profit organiation dedicated to promote wellness, health education and research for

the Afican Americans who live in Portland , Oregon. They are affliated with and

sponsored by varous health associations such as Legacy Health Systems , Providence

Health Systems, Kaiser Permanente, Northwest Health Foundation, Oregon Health

Sciences University, Centers for Disease Control and Prevention, Oregon Health

Division, Multnomah County Health Deparment , Group Health Community Foundation

National Black Leadership Intiative on Cancer, Substance Abuse and Mental Health

Service Administration. The Afcan- American Health Coalition has access to event

locations in its affliated facilities that the WDEC can utilize for its seminars.

The Afcan- American Health Coalition hosts many different programs throughout the

year. Some events that are currently pursued by the organzation are

        Not Afaid to Tal Test and Transform (NATTT), sponsored by SAMSA

    . REACH2010

        The Oregon Breast and Cervical Program

        Diabetes Screening and Service Linkage

        Walk for Life

        Wellness within REACH: Mind , Body and Soul
  4 Service    and Support



List of diabetes trained pharacists in the Portland district and store locations:

Amela Brankovic , RPh, MS             Store #07119
                                      5420 NE 33 rd Avenue
                                      Portland , Oregon 97211
                                      (971) 230- 0153

Chrs Caswell , RPh                    Store #03925
                                      3 NE 82nd Avenue
                                      Portland , Oregon 97220
                                      (503) 408- 0729

Tina Le       Phar                     Store #06140
                                       1620 NE Grand Ave
                                       Portland , Oregon 97223
                                       (503) 493-2745

Joane Marin,     Phar                  Store #03123
                                       2103 W Burnside
                                       Portland , Oregon 97210
                                       (503) 295- 6480


Linh Ta,      Phar                     Store #04545
                                       3909 SE Holgate Blvd
                                       Portland , Oregon 97202
                                       (503) 777-2893
   Timeline

Walgreens ' Diabetes Awareness Program project will be implemented by WDEC for a

span of6 months. Ifwe star this project in Januar event planning wil take place until

Februar. Plannng    within the fist month wil   include   delegation of task to commttee

members. The ftrst series of educational seminars take place in mid Februar, and each

consecutive educational seminar wil follow after two weeks at different location venues

based on availability. Over a period of3 months, 6 consecutive seminars wil      be held


until the beginning of May. One month is required following the last educational seminar

to gather statistical data ITom reports obtained ITom store #07119. Data gathered wil

include coupon utilization at the store, average sales, prescription sales , and customer

feedback.




     Prjec   Pla                      Mach            Apri
                                                                          I Dm
                                                                        May                 June
Janua                 Feb.




Two weeks before each event , delegated task will be doubled checked by the WDEC.

        Update presentation slides for each event and make copies for paricipants

        Contact Afcan-American Health Coalition to confrm location

        Check list of volunteering Walgreen Pharmacists, Pharmacy Techncians , and/or

        Pharmacy Interns and their specific tasks for the event

        Prepare sign up sheets available for optional special programs such as Brown

        Bags
One week before each event

      Confrm food and beverages orders

       Send reminder emails ,   phone-calls, postcards to registered paricipants

       Gather supplies for glucose screening and blood pressure



Three days before each event

       Email volunteers for confrmation and event details (location, time, task

       assignments)

       Contact Afcan-American Health Coalition for additional confrmation and

       updates

       Gather equipment needed for presentation (projector, laptops)

       Gather and store supplies and equipment gather and stored at the corporate offce



Day of the event

       Committee members will bring supplies and equipment to the seminar location

       Elephat Delicatessen wil deliver food to location

    . Afcan-American Health Coalition wil         prepare location   site for the event (chair

       set-up, tables)
 0 Price List

Each paricipant wil be charged $10. 00 at the entrance. All transactions wil be cash.


 0 Financial Statements

Capital
Computers: Laptops (2)                     000
Projector                               $500
Softare                                 Included in laptop purchase
Stethoscopes (3)                        $300
Sphygmomanometers (3)                   $60
Proj ector Screen                       $160

       Capital Total: $4 020

       Total per event: $2 355

       Total cost of pilot program:           $18 150

       Exected parcipant contrbution:
                                                     $10 x 100 x 6 = $6 000

       Net Total: $12 150

Estimated Per Event

Location                                                $700

Glucose testing supplies:                               $20
(alcohol , bandages, cotton balls)
Biohazard waste container (2 per event)                 $10

Food: Caterer + Delivery Fee                            $9. 00 x 100 = $900

      Beverages (Walgreens)                             $75

Advertising: Newspaper                                  $100

Printing Cost: presentation slides + survey             $15 (4 pages)

Postage and Postcard                                    $30 for postage, $5 postcard

Coupon                                                  $500

TOTAL:                                                     355
  Appendix A:

Organizational Chart
Appendix B:

  Resumes
                                  TINA K. LE

915 SW Adams Ave                                  Email: tinale healthcare. com
Portland, OR 92666                                Phone: (503) 567- 1289

Work Experience
2000- Present                                      Walgreens Pharmacy, Portland , OR

1998- 2000                                                            Portland , OR
                                                   Providence Hospital ,
                                                   Ambulatory Care Unit

1997- 1998                                         Residency - General Practice
                                                   OHSU - Dornbecker Hospital

1995- 1996                                         Internship - Walgreens ' Pharmacy
                                                   Portland , OR

Education

1994- 1997                                         Doctor of Pharmacy
                                                   University of Washington, WA

1992- 1994                                         Bachelor of Science in Biology
                                                   Portland University, Portland , OR

1991- 1994                                         High school Education
                                                   Ngo Quyen High School , Vietnam

Certifcation and Special Trainings


    Diabetes Training, Walgreens Corporation, Chicago , IL (2003)
    Diabetes National Symposium, San Francisco , CA (2002)
    Certification ITom American Diabetes Association (2002)
    Managed Care and Ambulatory Care Training, Providence Hospital (1999)
    Diabetes Managed Care Training, OHSU (1997)
    Certification ITom Utah School of Alcoholism and Drug Addiction (1996)

Reference

Available upon request
                                                       Joanne Ann Martin
                                             Email:     Joane. Ma(iwalgreens. com
                                                                       th Avenue
                                                         3110 SW 13
                                                        Portand, Orgon 97239
                                                            (503) 222-2342


Education:
                      Communtyl Ambulatory Phancy Residency Progr
                      University of  Wasgton Seatte     , Wasgton
                      July 1 , 2002 - June 30 , 2003


                      Docor ofPhacy
                      Orgon Stae University                    Corvallis. Oregon
                      Graduaed June 2002

                      Bachelor of Science in Geera Science
                      Oregon Stae University Corvals, Oregon
                      Graduaed June 15 , 1998
Exoerience:
July 2003 -           StaPhacist
Present               Walgreens
                      Portand, Orgon
                          Counled paents on their prescptions
                          Worked with phacy            st to   fi prescriptions



June 2000 -
                      Phacy Intern
September 2000,       Walgreens
                      Portan Orgon
June- 2001 -
September 2001           Worked with phacy             st to   fi prescptions


                      Phacy Inemlechnci
June 1999-
                      Kapi' olan Medca Center for Women & Chidren (In-Patient Phacy)
August 1999           Honolulu. Hawai
                          Prepared and distbuted varous medcations prescrbe to admtted patients
                          Assisted in restockig medcaons in the           phacy
                          Collaborated with the Phacy Mager on a projec (hospita policy/procure)

 October 1993- June   Student Worker
 2000                 Ofce of Admssions
                      Orgon Stae University           Corvals. Oregon
                          Assisted Evaluators by inputtg confdental docents in computer databases
                          Worked with other stden workers on spial project
                          Met const deaes

                      Sales Representative
 January 1992-
 September 1993
                       Sune    Bakery
                      Honolulu. Hawai
                          Assisted cuomers in puchag decision of Japaese organc  and breads paes
                          Assisted bakers with display of baked goos
                      . Mataed stda foo and heath coe regutions of the workplace
                       Resident Assist
 April 1995- June
 1996, September
                       Hawley   Haest  IntertionaHa
                       Orgon Stae University Corvals, Oregon
 1996- June 1997
                           Admstere and interpreted unversty rues and reguatons in the residence has
                           Responsible for   m::inminin g    seurty and    domestc nee
                           Medated confict by         faciltatig and   cordig communcation between two or more paes
                           Planed and cordited           actvities and   progr in order to creae a heathy communty among
                           residents
                                                          Joanne Ann Martin
                                                Email:     Joane.        walgreens. com
                                                                      1h
                                                            3110 SW 13 Avenue
                                                           Portan Orgon 97239
                                                              (503) 222-2342


September 1994-           Academic Succss Progr          Assistt
March 1995                Hawley
                           Orgon Stae University Corvals, Orgon
                              Planed and coordited actvities and progr focu on Academic Succss
                              Interpreted unversity rues and reguations in the residence halls
                              Acculated capus resources for residents
Activities:

Ocober 1998 - June 2001       America Phacist Assocation Student Member
                                   Opration Diabetes Commttee 1998 - 2001
                                   Opraon    As          Commttee 1998 - 2001
                              Nationa Communty Phaacist Assoation Stuent Member
                              Orgon Heath Socety ofPhacist Student Member
                              Orgon Stae Phacist Assoiation Student Member
                              Phi Delta Chi Fraernty Member
                                  Brown Bag Coorditor 2000 - 2001

Janua 1999 2000 2001          Patient Counselig Competition Parcipat
                                      place for Oregon State University 2001

June 1997 - June 1998          Oregon Stae University Pr-  Phacy Prsident
October 1994 - June 1998       Oregon State University Pre-Phacy Member
                               355 SW 10 th Street Apt # 3       Tel   : (916) 999-2727
                               Portand, OR 97239                 E-mai: li.       a1gr. com

Linh P. Ta

Work Experience
             2000 - present                   Walgreen       Phacy, Portand, OR
             1998 - 2000                      UCSF general Residency, San Fracisco , CA

             1997 - 1998                      Outpatient Diabetes Education Program
                                              San Jose, CA

             1995 - 1997                      Rite Aid   Phay intern Sacraento, CA
Education

             1995 - 1998                      Doctor of Pharacy
                                              UCSF , Sans Francisco , CA

              1991 - 1995                     Bachelor of Science in Biochemistry
                                              UCDavis , Davis, CA

              1988 - 1991                     High School Education
                                              Thu Khoa Ngha High School , Vietnam

Certification and Special Trainings

              Diabetes Training, Walgreens Corporation, OR (2003)
              Diabetes educator, San Francisco , CA (2003)
              Diabetes Education and Self Management Program , CA (2002)

Community Actvities
             Member of APhA Academy of Students of Pharcy
             Member of America Diabetes Association
             Member of America    As   Association

Awards
             Walgreen s pharacy Employee of the year 2002
              Fra and Ester Golden Phacy Scholarship 1998
             Walgreen s Co. Scholarhip 1997

 Reference
              Available upon request
Appendix C:

   Forms
Thank you for participating

        -i *




               Diabetes Awareness
                                 Program
       For your involvement  you are entitled to a
                    $5. 00 Coupon
       redeemable only at Walgreen Store #07119
        5420 NE 23      Portland, Oregon 97211




                                                                             YOU'


                         $5. 00 Coupon
                          excludig any   alcoholic and or tobacco products

         ca only be reeemed at Walgreens Store #07119
Ths coupon
Located at: 5420 NE 33
                Portland, Oregon 97211
Orgi coupon wi only be accepted.
Coupon may not be combined with an other offer or coupon.
No cah reemption value. Nontanerable.
         The Walgreens Diabetes Educational Committee
                                     Presents
                       An Educational Seminar on

                      DIABETES AND CHIDREN

                    When:                     May 20th, 2005
                    Time:                     2pm - 5pm
                    Where:                    Legacy Emanuel Hospital
                                              McKenzie Hall Room 100
                    Fee:                      $10.

Presenters:                        Tina Le  Phar.
                                   J o an MarinPhar.
                                   Linh Ta, Phar.

What you need to know about Diabetes in Children and how
to help your child live a normal , healthy and fun- filled life

   . Complimentar white box lunch and beverages
   . Free   manual blood pressure checking
   .   Free glucose level testing
   .   Assessing your risks for diabetes
   .   Question and answer session dedicated to your needs

Registration taes   place   at the Afcan- American Health Coalition Center and at
varous Walgreens     locations.
Registration by phone (503) 456- 6000 or by email semiars walgreens. com
Registration is limited to 100 paricipants
              Diabetes Awareness Program

             Thank you for participating in our seminar today


We would certainly appreciate your comments about this seminar:


On scale from 1 to 10 , how does ths semiar inuence your perception
about Walgreens?


            Least 1 2 3 4 5 6 7 8 9 10 Most

Were you sacrificed with our servces?                      Yes

Did you fid our   presentation useful?                     Yes No

Are you considering attendig   the next seminar   event?   Yes No
Will you use your coupon at Walgreens?                     Yes No



Please wrte down any comment about presentation
Dru,g Name   Stren,g / Formulation I Si,g. Fi,g   Wht for? / How   ta,g it ?   Dru,g Interactons / Comments
            \.
                                                                                       Diabetes Awareness Program
            II                                                                               Brown Bags
Drug Name                          Strenmh / Fonnulation Si,g, Fi,g   Wht for? / How   ta,g it ?   Drug Interactons / Comments




Chages or recommendations for drg medcation therapy:




Reviewed by
       Supplemental:

      Presentation Slides


Brown Bags Service Description
                                                             ,j


   Diabetes & Children                                            Type I
                                                                  . Typ I diabees is also known as juvenile
                                                                    diabe
                                                                  . Everyday, 35 children  in America are
                                                                     diagnosed with Typ I diabees
                                                                  . The risk of developing Typ I diabees is
                                                                    virtually higher than all other chronic disease
                                                                    of childhood
                                                                  . Peak incidence occurs during pubert, around
                                                                    10 to 12 years of age in girls and 12 to 14
                                                                    years of age in boy




                                                                  The Good News
"4 Type                                                           . Diagnosis of   diabees toay is not
   . Type 1   diabes tends to run in familes. Brothers and
     sistrs of children   wi type I diabetes have about a           negative as it used to be
     10% chance of developing the disese by age 50
                                                                  . Nowadays, children with diabetes have
   . There is a higher incidence of type 1   diabes in              more options for blood glucose testing
     Caucasians than in oter racial groups.                         and insulin administration than ever
                                                                    bere
   . The   identical twn of a persn
                                 wi type 1 diabetes
     has a 25-50% higher chance of developing type 1              . New developments are    occurring
     diabet than a child In an unafecd family.                    . With proper daily care and treatment
                                                                    children with diabetes today lead
                                                                    healthy, active, and fun- filled life




   Type I Diabetes                                           "j What Are The Sy mptoms?
   . The mos common form of the disease in                        . Tirenes
     children
   . Caused by the    inability of the pancreas to                . Thirst and fruent drinking
      produce insulin. The cause is not yet known                 . Frequent urinating
      but can be due to infecions, environmental
      and hereditary factors.                                     . Beetting
   . It is dassified as an autoimmune disese,
      which means that the body' s immune syem                    . Loss of appetiteand weight loss
      atacks its own tissues or organs.                           . Infecions on skin or around the mouth-
   . The onset of children s diabees usually
     occurs in lat childhood but can preent itslf
                                                                    particularly due to yeast (Candida), or
     from early infancy through to late adulthood.                  boils
..


                                                                               How Is Diabetes Treated In Children?
,. What Can Paren ts Do?
     . Know the syptoms of low blood gluco and        high blood              e " honeymoon perod" is up to a yea r aftr the diagnos     is made
        gluco and what to do about them                                     when the child may nee onlY a small dos of insulin
     . Meare blood gluco levels and tech the child how to do this
       as son as they are old enough                                                 children
                                                                          . Typically,          are capable of injecting insulin themselves around
                     how
     . Teach the child        to sef-adminisr insulin injecons as son       9 years old
       as they are old enough
                        alwys
     . Make sure sugar is          nearby for the trtment of low          . Injectionsare   into the skn either in the abdomen or the th ighs but
       blood sugar                                                          can be injeced anywere that has suffient skn
     . See doctr on a reular basi or     if the child devlops another
       disese                                                             . Ver small children normally don t nee an injecon at night but will
                       and
     . Inform the school        frnds, about the symptoms of low blood       nee one as they    gro older
       gluco
     . Contact your local   Diabetic Asciation for help and support                      can use short-acting insulin before every main meal
                                                                          . Older children
                                                                            and long- acing insulin at night

                                                                          . Insulinis   typically given in insulin pens with very fine neele




     Managing Your Child                   s Diabe
                                                                         "" What Your Child                              an Do
                                                                                                         importnt because the pancreas is
     . Monitoring bloo glucose levels                                          . Insulin shots are
                                                                                   not producing insulin to take care of the amount of
     . Injecing       insulin                                                      sugar from meals
                                                                               . It is not  necesry to give up          any foo itms as long
     . Developing a meal plan                                                      as they are accounte for in the meal plan and
                                                                                   insulin  dos are adjust
     . Paying attention to eating habit                                        . Exercis is Importnt. It          helps lower bloo sugar and
                                                                                 maintain a healty          acte lifste.
     . Exercise                                                                . Alwys carr      gluco tablets, sugar cubes, or hard
                                                                                   candy in case of lo bloo sugar
     . Emergency glucose                supply                                 .   Do not feel reluctnt to tell friends about their
                                                                                   diabetes
                                                                               . Remember: diabete is not a shame. There is
                                                                                   nothing wrong they have done.
..                      :,




     Diabetic Medica ions                               Sulfonylureas/             glitinides
                                                         . Acetohexamide (Dyelor)
                    (f. c "                              . Chlorpropamide (Diabines)
                       'l'    ii.                        . Glimepiride (Amary)
                               r'''.                     . Glipizide (Glucotrol , Glucotrol XL)
                             '!!L.                       . Glyburide (Glynase PresTab, Micronase)
                                                         . Tolazamide          (Tolinase)
                                                         . Tolbutamide         (Orinase)
                                                           Repaglinide         (Prandin)




"" How They Work                                                          Watch   (:ut For
                                                   -1What To thes drugs and skip mel , insulin
                                                              take
                                                         . If you
     . They work by making your
                                                       level in your bo is more than your sugar
         produce more insulin beuse your               level. This will lead to dangerous low blood
         pancres does not make enough insulin              sugar level.
         to overcome insulin resistance
                                                         . Weight gain is possible. Thes drugs help
                                                           increse insulin in your body to take in sugar
     .   By having more insulin , your bloo                from your meals, therefore, you may gain
         sugar level wil come back to normal               weight. The sugar that would go out in urine
                                                           now stys and is stored in your boy.




     Thiazolidinedion                                    What To Know Abo t These Drugs
'4   . Newest class of diabetic drugs on                 . You can use them together with   other
       market                                              of diabees medicaions like Glucophage
                                                           (Metrmin) and the sulfonylures
     . Rosiglitazone
     . Pioglitazone
                         maleate (Avandia)
                      (Act)
                                                         . Their    eff will add up beause they work
                                                           diffrently on different part of the body
     . These drugs work by making your                   . You won t get a low blood sugar, even if you
         more sensitive to the amount of insulin           skip meals.
         that is prouced in your boy.                    . Also, they don t upst your stomach or cause
                                                           diarrea like meormin can.
 What to know about these
..drUgS                                                Metformin (Glucophage)
 . Thiazolidinediones are unusual," that they          . This drug works by incresing
   take a long time to strt   workng - someime          sensitivty of your tissues and organs to
   up to six weeks
                                                          insulin prouced in your boy
 . Do not   ex to se eff
 . They can cause weight gain and
                                 aftr your
                                    fluid
                                             1st pil
                                                       . It can derese your appetite so your
   retention                                              may lose some weight (goo news)
 . The FDA has recommended that every                  . It can cause GI upst and diarrhea.
   paent who is taking them should have their          . Taking it with meals wil help decrese
   liver blood tesevery two months.                     the side
 . These are not the first drugs of choice




 special Advice
 . Do not  chew or crush tablets that are
      , SR, ER, LA or any exended-release
   forms beuse the tablets wil not work
   properly as a result
 . Take your meications and meals
   accordingly to plan to avoid any
   incidence of hypolycemia or
   hyperglycemia
 . Always have your glucose tablets ready
                                                              Types of Sugar in Nature
                                                           . Regular table sugar is     called sucrose
                                                           . On label other sugars     with chemical name end
                   Diabetes                                  with " -ose " : glucose , fructose , lactose and
                                                             malose
                                                                                             alcohol: sorbitol
           Nutrition a. Exercise                           . Other carbohydrates are sugar
                                                             xylicol and mantols
                                                                                                      sugars:
                                                           . Natural and process foods are very high in
                                                             corn syrup, sugar cane syrup, honey, sweetened
                                                             condensed milk and chocolate
                                                           . Sucrose may have big   effect on your blood
                                                             glucose levels than others




    Low Calorie Sweeteners                                            Reading Food Label
. chemical sugar and safe to use                              Sugar free /1 does not
. sweet taste , have no calories , and   do not raise        mean that it is calories and    Nutrion Fact
  blood glucose levels                                       carbohydrates- free-                           :z,
                                                           . Calculate amounts of            __.BO     ""f"I'!I
. The American Diabetes Association accepts that             nutrients per serving
  these sweeteners a re safe                               . Calories
. Saccharin: can use in hot and cold foods                 . Total fat
. Aspartame: use in cold food , containing                    Saturate fat                           - 'Oi -
  phenylalanine. Be aware in people have
  phenylketouria disease                                   . Cholesterol
                                                           . Sodium
                                                                                             -21
. Cralose: can be used in any beverages ,     bake         . Total Carbohydrate
  foods or processed foods                                 . Fiber
. Acesulfame potasium: can be used        in all cooking   . Sugar alcohols




               Eat healthier                                      Diabetes Food Pyramid
                                                           Diabetes Food Pyramid
. What you eat makes a difference
. Making few changes in your eating
  habit by reading food labels
. Choose to eat more fruits and
  vegetables and less on meats and
  sweets
. Diabetes food pyramid can help you
  to decide what to eat right
     Setting your eating style                                     In The Kitchen
. Eating a wide variety of    new food every days       . Gather recipes that use less meat , more
. Eating a high- fiber   foods such as fruits             grains , bean and vegetables
    vegetables, whole grain and beans
. Limit saturate fats
                                                        . Cut off all visible fat prior cooking
. Cut down on animal    protein foods: meats , whole    . Take off the skin of poultry
    milk dairy foods and high fat cheese                . Use the fat- free milk/yogurt
. Avoid sugary foods: cookies, ice cream , jelly
   beans....                                            . Prepared vegetables at least 3 serving a
. Limit added salt and    sodium processed foods          day
. Limit regular soft drink and alcohol                  . Keep a bag of pre-cut   or baby carrots
                                                        .. Make a big salad , store in refrigerator




            Routine Excercise                                         Being active
. Find out which activities will be safe for you        . Try to accumulate 30 minutes of
. Learn your blood glucose response to exercise
. If your blood glucose is high before you exercise
                                                          physical activity every day
    physical activity can make it go even higher , so   . Walking, taking stairs , doing more
    be cautious about doing something active
. Learn how to avoid low blood glucose by
                                                          ya rd work
    symptoms and water and snacks handy during          . Go dancing, play tennis , swimming
    activity
.   If low blood glucose is interfered with your        . Lift light weights at home
    routine exercise , eat snack before you exercise    . Join a class to do strength training
                                                          with weights
               ..,._. _.__..._                  ;;
                                                ;;j
                                                ;"




                                                     How Do Diabetes Complications Affect
     African- Americans and                          African Americans?
        Diabetcs- Related                            o Afcan Amercan have hier rate diabete        complications
                                                       compared to white Amercan
       Complications                                 o Four most diabetes complication afectAfcan Amercan:
                                                       - Cardiovasular   die
                                                       - Blidness
                                                       - Kidney Faiur
                                                       - Amputation




Factors Influence the Frequency of
These Complications                                  Cardiovascular Disease
c Delay in diagnosis and treatment of                o People with diabete ar frve ties more liely to suer
                                                        stkes than people without diabete
 diabetes                                       ;;   0 Once diabete have a stroke, they have 2 to 4 ties as likely
c Denial of diabetes                                   have a recuren
c Abnormal blood lipids                              0 Deth from hea     dise in women with diabete have
                                                       increaed 23 % over the pat 30 yea compared to a 27%
c High blood pressure                                  decreae in women without diabetes
c Cigarette smoking                             i)   0 Deth from hea disese in men with diabet have decreaed
                                                       by onl 13% compared to    a 36% deceae in men without
                                                       diabete




Wl1Y diabetes can cause kidney disease?              Kidney failure statistic
c Function of Kidneys is to filter and remove        c African Americans experience kidney
 waste products from blood                             failure from 2. 5 to 5. 5 times more often
c High level of blood sugar make the                    than white Americans
 kidneys filter too much blood. After many      ;1 c    Diabetes cause 32. 5 percent of end-stage
 years , the filter start to leak and useful            renal disease (kidney failure) cases in
  protein is lost in urine
c The kidneys loss their filtering abilty.              African Americans
  Waste products then start to build up in
 the blood
Symptoms and diagnosis of kidney
disease                                                   Visual Impairment
D No symptoms until almost all kidney function is         D African Americans have 40% higher rate in
  gone                                                     frequency of severe visual impairment compared
D Symptoms of kidney disease are not specific              to white American
D First symptom often is fluid build up
                                                    " D    Compared to white women , black women are
D Other symptoms of kidneys are:
  - loss of sleep                                           three times more likely to become blind from
  - poor appetite                                           diabetes.
  - upset stomach                                   :m D African-American men have a 30% higher rate of
  - weakness                                             blindness from diabetes than white American
  - difficulty concentrating                             men
                                                       D Diabetic retinopathy may occur more frequently
                                                         in black America than white




Eye complications                                         Amputation
D Diabetes cause eye problems and may lead to                     people los their foot or leg to diabetes each year
                                                          " 82, 000
  blindness                                               " Among peple with diabetes , African- Americans are l.S to
                                                              S times more likely to suffer from lower limb amputations
D Glaucoma: more likely occur in 40% of diabetes          " Diabetes is the most frequent cause of non-traumatic lower
  risk also increase with age. The vision is                limb amputation
  gradually lost                                          " Risk of leg amputation   is 15 to 40 times greater for diabetic
                                                            people
D Cataracts: more likely occur in 60% of diabetes         " More than 60% of non-traumatic lower limb amputation in
D Retinopathy: diabetes damage retina and cause             the US ocaJr among people with diabetes
  loss of vision. The risk increase with ages




Neuropathy and nerve damage                               Skin complications
D One of the most common complications of                 D Diabetes cause skin disorder
  diabetes is diabetic neuropathy                   ;, D Sometimes     it is the first sign of diabetes
D Can cause pain and disable                        ;i:   D People with diabetes get infection easily from
D Symptoms often go away after several                      - Bacteria: cause infections of glands of eyelid or
                                                            hair follcles
  months                                                    - Fungus: often Candida albicans ,          jock itch
                                                            athlete s foot , ringworm and vaginal infection
                                                            - Itching: caused by a yeast infection, dry skin
                                                            or poor circu lation
How to Prevent Diabetes
Complications?
o Glucose control
o Blood pressure control
o Blood lipid control
o Detect and treatment of diabetes eye
  disease
o Foot examination
o Skin examination
      ".




                            AJUe
                                                 What will be discussed...
                                                       What is gestational diabetes?
  Gestational
                                                       What causes this condition?
   Diabetes
                                                       What are the risk factors?
        presented by
   Joanne Martn , PharmD.                              What should I do about it?
Joanne. Martn(1walgreens. com




                    Diabetes                       What is gestational diabetes?
 . Condition tht effects a persn s body to       . Afect 3 - 5 % of pregnat women in the
   produce or respond to                          United States
   In     is a hormone workig with glucose       . Charcterd as high
                                                   dur pregncy
                                                                       blood glucose (suar)



   In
   (suar) to get energy
            from the pancras, helps glucose to
    enter your cells
                                                 . Generay developed
                                                  trester
                                                                       in the secnd or thd

 . Pancreas always secretes




    What causes this condition?                      What are the risk factors?
 . Placenta producin hormones, grows larger      . Famly History
   in second and thd        trests               . Weight
 . Hormones: estogen, cortsol ,      human        . Race
   placenta lactogen                              . Complicated   Prgncy
 . Requment for pregncy but increass
    cell resistace to
             Family History                                             Weight
. Chaces increass if a close family member           . Bein overweight    before pregncy
 (example: parent, siblin) has type 2                  increases your chaces of gesttiona
 diabetes                                              diabetes
                                                     . NOTE:  gai      a lot of weight durg
. Type 2 Diabetes
    onset or non-   in
                     formaly known as adult-
                        dependent diabetes             pregncy does NOT cause gesttional
                                                       diabetes
                                                     . Your obstetrcian   wi recommend       a taget
                                                       for weight gai




                     Race                              Complications from previous
                                                               pregnancy
. Reasons    unown
. Some    women ar more liely       to develop
                                                     . Stibir
    gesttional diabetes then others                  . Large baby

. Resechers      believe "thrift   gene "   may be   . Gesttiona    diabetes
    the cause of tye 2 diabetes
     Th gene         proteti cert
    populations from staation




     Why should we worry about                        Why should we worry about this?
               this?                                           continued..
. Risk of macrosomia, lage baby                      . Increase risk of stibir      or death as a

. Development of hypoglycemia (low blood               neworn
                         bir
.
    suar) shorty afer
    Babies born prematuely to mother with
                                                                          fu pregnancy
                                                      . Greater risk of developing gestationa
                                                        diabetes agai in
    ths condition develop respiratory distess         . Development of tye     2   diabetes in mothers
     syndrome
. Jaundice
   What should I do about it?                                  Seeking Medical Advice
. Seek medical attention                                  . Seeing obstetrcian forreguar checkus
. Screenig and diagosis                                   . They may refer you to other health
                                                            professiona  specia     in mangi
                                                            diabetes
                                                          . Exaple: endocriologist       registere
                                                            dietitian diabetes educator




         Screening & Diagnoses                              What to expect from the test
. You may not be       scened if you re tmder 25          . Fastg for 6 hours before the test
  yeas and have no other risk factors                     . For test, asked to    dr
                                                                                  a glucose solution
. Screenig     consist of a glucse chaene                 . An hour late,   blood is drwn and your
  test                                                      blood suar is checked
. Done    durg the 24th and 28t           week of                            is needed, overght
                                                          . If a follow up test                      fas
  pregnancy                                                 and a higher concetrtion of glucose
                                                            soluton is given




         Findings from the test                                            Treatment
. Most people , after fast, have levels
                                                           . Monitori blood suar
  between 70 and 110 miams      of glucose pe
  decilter of blood (mg/dL)                                . Eati healthy diet
  (eqivalent to 1 tepoon of sugar in a gallon of wate J    . Exercise

. Less then 140     mg/dL = normal        fast             . Medications
  glucose                                                  . Baby health before    bir
. Over 140  mg/dL warts follow up test                     . Copin skis
. Two incidence high blood sugar = gestationa
   diabetes
- ,




                       Special Optional Service: Brown Bags
      Brown Bag is a service at the educational seminar based on staf availabilty and

      customer registration. Customers have a one on one opportnity     to meet with


      pharmacist or pharacy intern to review their medications and have medication questions

      answered. Pharmacists or interns review customer s curent mediations including any

      OTC , supplemental , and or natural products. We look for any drug and food interactions

      therapy duplication, optimal medication intake scheduling, and drug expiration dates.

      Customers are required to pre-register for the Brown Bag servce prior to each seminar

      via email at   diabetes. ed. oregon walgreens. com or via phone at (503) 493- 2715



      Once customers are pre-registered, they are instructed to bring a bag of their medications

      used on a daily basis to the educational seminar. Contents in bag should also include any

      other medications that are used on a PRN basis (i. e. AP AP for headache), and a list

      customer s schedule of medication intake. Customer consultations are held after the

      seminar topic presentation


      Required for this service:
            . Pharacists ,    pharacy interns (based on availability) to counsel patients
                 Drug information resources (prescription drugs , natual products)
                 Designated private room or area at the seminar
                 Copies of medication list review forms to be filled by pharacists or pharmacy
                 interns
 -'




,ro

				
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