ABSTRACT
Background: Semaglutide and liraglutide are glucagon-like peptide 1 receptor agonists (GLP-1 RAs) approved by the US Food and Drug Administration for patients with type II diabetes mellitus (T2DM). Patients with T2DM treated with liraglutide at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) were converted to semaglutide. The primary objective was to assess changes in glycemic control and cost savings that resulted from this conversion. Methods: We conducted a retrospective chart review of veterans without retinopathy treated at MEDVAMC between March 1, 2021, and November 30, 2021, who were converted from liraglutide 0.6 mg and 1.2 mg daily to semaglutide 0.25 mg weekly (titrated to 0.5 mg weekly after 4 weeks). We compared hemoglobin A1c (HbA1c) values at baseline and 3 to 12 months following conversion to assess glycemic control. Cost savings were evaluated using outpatient pharmacy data. Results: During the study, 411 patients were converted from liraglutide to semaglutide; 49 additional patients met the criteria for clinician education, and 14 were converted as a result. In total, 304 patients met the criteria for inclusion. At baseline, patients' mean (SD) levels included: HbA1c, 8.1% (1.5); blood glucose, 187.4 (44.2) mg/dL; and body weight, 112.9 (23.0) kg. Three to 12 months postconversion, patients' mean (SD) HbA1c significantly decreased to 7.6% (1.4) (P < .001), blood glucose decreased to 172.6 (39.0) mg/dL (P < .001), and body weight decreased to 105.2 (32.3) kg (P < .001). Cost savings exceeding $400,000 resulted from liraglutide to semaglutide conversion. Conclusions: Conversion of liraglutide to semaglutide led to significant HbA1c decrease and weight loss and resulted in minimal changes to patients' antihyperglycemic regimen. Common adverse effects included hypoglycemia and gastrointestinal intolerance. Due to the low conversion rate of liraglutide to semaglutide following education, a more effective method of education for clinicians to promote teleretinal imaging before conversion is warranted. Lastly, although the semaglutide cost savings initiative at MEDVAMC resulted in significant savings for the institution, a full cost-effective analysis is needed for further conclusion.
ABSTRACT
In patients with T2DM and ESRD, insulin is the antidiabetic medication of choice with a hemoglobin A1c target of 6 to 8%, using fructosamine levels or other measures for better assessment of glycemic control.
ABSTRACT
BACKGROUND: Point-of-care (POC) testing devices allow laboratory monitoring to be performed in various settings and accessed immediately. OBJECTIVE: To evaluate the outcomes of monitoring anticoagulation patients in pharmacistmanaged, multicenter clinics utilizing i-STAT POC machines. METHODS: This study was a retrospective, multicenter chart review of 150 patients before and after implementation of the POC intervention for anticoagulation monitoring. Data collected included international normalized ratio (INR) results, indication for warfarin, minor and major bleeds, thromboembolic events, emergency room (ER) visits, and hospitalizations before and after i-STAT POC implementation. RESULTS: The time in therapeutic INR range (TTR) was significantly higher after i-STAT POC implementation than before implementation (60.4% ± 21.2% and 52.5% ± 21.5%, respectively; P = .0001). There were no reports of major bleeding during the study period. Twenty-three minor bleeds were reported after i-STAT POC implementation compared to 19 events before implementation (P < .0001). One thromboembolic event was reported after i-STAT POC implementation. There was a significant difference in the number of hospitalizations before i-STAT POC implementation as opposed to after implementation (2 and 0, respectively; P < .0001). There was also a significant increase in ER visits after i-STAT POC implementation (P < .0001). CONCLUSION: The results of the study indicate improvement in TTR in pharmacist-managed anticoagulation clinics by 7.8%. Although the use of the i-STAT POC machine detected an increase in minor bleeds, thromboembolic events, and ER visits, there was a decrease in hospitalization. The outcomes of this multicenter study indicate that implementation on this scale provides improvement in regard to safety and cost.
