Weight loss differences seen between glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors for treatment of type 2 diabetes.

BACKGROUND: Weight loss is an advantageous quality for diabetic medications because it can improve insulin sensitivity and glucose control and reduce cardiovascular risk factors and comorbidities. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are both preferred agents for use after metformin therapy, and both cause modest weight loss. OBJECTIVE: The aim of this study was to evaluate the difference in weight loss between GLP-1 receptor agonists and SGLT-2 inhibitors in patients with type 2 diabetes (T2D). METHODS: This was a retrospective study that was conducted at a level 3 patient-centered medical home in Buffalo, NY. The participants were adults with T2D treated with either a GLP-1 receptor agonist or an SGLT-2 inhibitor, in addition to background diabetes medications, between January 1, 2012, and September 20, 2017. The outcome measures included the median weight loss after 6 months of consecutive therapy compared between the 2 antidiabetic classes and the median differences in blood pressure, glycosylated hemoglobin (A1C) levels, and renal function markers compared between the 2 classes. RESULTS: A total of 73 patients were included in the final analysis, with 31 receiving SGLT-2 inhibitors and 42 receiving therapy with GLP-1 receptor agonists. The SGLT-2 inhibitor cohort presented a median weight loss of -2.80 kg (interquartile range [IQR] -5.40 to -1.50), and the GLP-1 receptor agonist cohort presented a median weight loss of -1.15 kg (IQR -3.38 to 0.975) (P = 0.014). There were no statistically significant differences in A1C levels, blood pressure, or renal function markers. CONCLUSION: SGLT-2 inhibitors, when used in combination with background diabetes regimens, can lead to more statistically significant weight loss than GLP-1 receptor agonists without compromising renal function.

Effect of changing COPD triple-therapy inhaler combinations on COPD symptoms.

OBJECTIVES: To determine if symptoms changed after changing chronic obstructive pulmonary disease (COPD) triple-therapy inhalers to a less expensive regimen. STUDY DESIGN: Retrospective observational case-series analysis. METHODS: A quality improvement program was instituted to reduce drug costs associated with COPD inhalers between fall 2016 and spring 2017. Patients identified as taking an inhaled corticosteroid (ICS)/long-acting ß agonist (LABA) inhaler and a long-acting muscarinic agonist (LAMA) inhaler were changed to a LAMA/LABA inhaler and an ICS inhaler. Symptoms were assessed at baseline and subsequent follow-up using the COPD Assessment Test (CAT), with lower scores representing better symptom control. Then, a retrospective observational case-series analysis of 118 patient charts was completed. The primary outcome was mean difference in CAT score. Data were analyzed using a paired t test with an α value of 0.05. RESULTS: Of 118 patients included in the quality improvement program, 19 met the inclusion and exclusion criteria. The mean (SD) CAT score prior to the change was 15.53 (5.36), and the mean (SD) CAT score after the change was 14.68 (6.98). Symptom scores improved after the change, with an average difference in postchange and prechange CAT scores of -0.84, although this difference was not statistically significant (95% CI, -3.57 to 1.89; P = .525). CONCLUSIONS: Based on the results of this observational review, changing COPD triple-therapy inhalers did not result in a significant change in patient-reported symptom scores. Patients may use triple-therapy inhalers that are most affordable without a significant change in symptom control.

Scope of contemporary pharmacy practice: roles, responsibilities, and functions of pharmacists and pharmacy technicians.

OBJECTIVE: To provide an overview of the current context and scope of pharmacy practice, the range of professional services offered by pharmacists, and the supporting role of pharmacy technicians. DATA SYNTHESIS: A synopsis of the current state of pharmacy practice as it relates to the spectrum of professional roles and responsibilities, the diversity of patient populations served, the complexities of patient services provided, and various aspects of emerging pharmacy practice is provided. The current work focuses on patient care services provided by pharmacists; it does not address all possible activities of pharmacists, such as administration and general management. This is a descriptive analysis. It does not take a position regarding future changes but is intended to serve as a foundation for understanding the relationship and alignment between the profession's various mandatory and voluntary credentials and the scope of practice continuum. The key educational and credentialing standards for pharmacists and pharmacy technicians are summarized and referenced. CONCLUSION: The evolutions in health care and pharmacy practice are presenting many new opportunities for pharmacists to perform functions and provide services not considered as traditional roles. The profession of pharmacy is working to achieve a pervasive model and standard of care determined only by the needs of patients and populations. The Council on Credentialing in Pharmacy hopes that the material presented herein, including the framework for credentialing in pharmacy practice, will allow audiences to gain a better understanding of where pharmacy is today and what future pharmacy practice will look like.

Clinical and economic impact of a diabetes clinical pharmacy service program in a university and primary care-based collaboration model.

OBJECTIVE: To provide program methodology and outcomes data identifying the impact of clinical pharmacy services (CPSs) in patients with type 2 diabetes. DESIGN: Longitudinal pre-post cohort study. SETTING: Regional primary care group in Buffalo, NY, during 2006-2007. PATIENTS: Patients with type 2 diabetes identified by their primary care providers were referred to the MedSense program; a pharmacist-led, patient-centered pharmacotherapy management program developed through university collaboration with a regional primary care physician group. INTERVENTIONS: Education, clinical assessments, provider recommendations, and longitudinal follow-up of treatment goals provided by MedSense pharmacists. MAIN OUTCOME MEASURES: Clinical outcomes were followed for 1 year from the index date for primary diabetes endpoints (glycosylated hemoglobin and fasting plasma glucose) and accompanying metabolic parameters (body mass index, blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides). Economic endpoints from the payer perspective were also followed for 1 year from the index date for medical and prescription-related costs. RESULTS: Primary diabetes endpoints were significantly reduced versus baseline at the 6-month (-1.1%; P < 0.0001, -39 mg/dL; P = 0.003) and 12-month (-1.1%; P < 0.0001, -35 mg/dL; P = 0.005) assessments. Improvement rates were observed for all accompanying metabolic parameters at each assessment (range 40-64%). Geometric mean costs tended to decrease versus baseline at 6-month (-$84; P = 0.785) and 12-month (-$216; P = 0.414) assessments, despite nominal increases in diabetes and total medication costs. CONCLUSION: In this CPS model, there were initial and sustained reductions in the primary diabetes endpoints and a high rate of improvement for accompanying metabolic parameters. Concurrent with clinical improvements, total direct medical costs were reduced despite an increase in antidiabetic medication and total medication costs.