Table 5.

Immediate issues and co-existing issues identified and action(s) taken by pharmacists.

IMMEDIATE ISSUES IDENTIFIED	ACTION(S) TAKEN BY PHARMACISTS
1. Recent unstable glycaemic control (pathology, patient) and the need for changed/additional pharmacological intervention	Determine the rationale for the prescribed medication (insulin) and check appropriateness before supply
2. Current infection (venous leg ulcer) and the need for pharmacological intervention	Determine the rationale for the prescribed medication (antibiotic) and check appropriateness before supply
3. Drug-related precaution—duplication of hypoglycaemic agents predisposes to increased risk of hypoglycaemia	Clarify with patient changes to existing medicines that include cessation of gliclazide and exenatide with continued metformin use
4. The patient is commencing on new medicines requiring explanation of any changes/recommendations/device demonstration	Provide medicines information for patient including administration, dose, insulin injection technique
Co-existing Issues Identified	Action(s) Taken by Pharmacists
1. Patient is complacent towards non-pharmacological management of diabetes	Provide lifestyle advice to aid management, offer some education as to the importance of good self-management of diabetes
2. Patient has not been referred to diabetes educator and has not seen a diabetes specialist for a couple of years	Recommend referral to diabetes educator