Envisioning the Future of Student Success: Report of the 2022-2023 AACP Student Affairs Standing Committee.

Over the past several years, traditional metrics have indicated declining student success within colleges and schools of pharmacy. Though students may be less well-prepared for professional school than in years past, once candidates are admitted to our institutions, we have a responsibility to effectively support their progression through the program. The 2022-2023 Student Affairs Committee was convened to evaluate and advance the construct of student success within Doctor of Pharmacy programs. The Student Affairs Committee was charged with identifying environmental factors affecting the ability of pharmacy students to be successful; determining how colleges and schools of pharmacy are currently meeting needs related to student progress; conducting a literature review to determine what academic support measures minimize attrition; and developing innovative suggestions and recommendations that better support student success. To accomplish this work, we conducted an extensive literature review and synthesis of evidence, engaged in professional networking across the Academy, and administered a wide-ranging student success survey to all colleges and schools of pharmacy. In this report, we explore the complex and interacting systems that affect learning behavior and academic success and offer a novel, comprehensive description of how the Academy is currently responding to challenges of academic and student success. Additionally, we envision the future of student success, offering 7 recommendations to the American Association of Colleges of Pharmacy and 5 suggestions to members of the Academy to advance this vision.

An Evaluation of Nonacademic Predictors of Success in a Doctor of Pharmacy Program.

Objective. Pharmacy programs have struggled to predict who will be successful in their programs based solely on cognitive skills. The primary objective of this study was to determine which, if any, nonacademic factors are associated with on-time progression within the school of pharmacy curriculum.Methods. A survey was developed and offered to all Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy students in fall 2020. This survey included questions to collect demographic data and incorporated four validated questionnaires: the Grit-Grid, the Academic Pharmacy Resilience Scale (APRS-16), the Cohen Perceived Stress Scale (CPSS), and the Turkish Time Management Questionnaire (TTMQ).Results. Completed surveys were submitted by 213 students out of 569 (37.4% response rate). On-time progression rate was calculated separately for each class. Through binary logistic regression, we found that on-time progression was significantly associated with prepharmacy grade point average >3.20, high school Grit-Grid score >0.9, APRS-16 score >35, and CPSS score >34. Pharmacy College Admission Test (PCAT) composite scores and admissions committee rubric scores were not associated with on-time progression.Conclusion. Based on the results of this study, it may be reasonable to implement the Grit-Grid, APRS-16, and the CPSS in the admissions process to help determine the most appropriate candidates for our program or use them as screening tools for incoming students to identify who may be at academic risk. However, these factors need to be validated in pharmacy programs in other private and public universities before widespread adoption can be condoned.

Benefits of SGLT2 Inhibitors Beyond Glycemic Control - A Focus on Metabolic, Cardiovascular and Renal Outcomes.

BACKGROUND: Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new pharmacotherapeutic class for the treatment of Type 2 Diabetes Mellitus (T2DM). OBJECTIVE: To evaluate beneficial effects of the SGLT2 inhibitors on metabolic, cardiovascular, and renal outcomes. METHODS: A Pub-Med search (1966 to July 2017) was performed of published English articles using keywords sodium-glucose co-transporter 2 inhibitors, canagliflozin, dapagliflozin, and empagliflozin. A review of literature citations provided further references. The search identified 17 clinical trials and 2 meta-analyses with outcomes of weight loss and blood pressure reduction with dapagliflozin, canagliflozin, or empagliflozin. Three randomized trials focused on either empagliflozin or canagliflozin and reduction of cardiovascular disease and progression of renal disease. RESULTS: SGLT2 inhibitors have a beneficial profile in the treatment of T2DM. They have evidence of reducing weight between 2.9 kilograms when used as monotherapy to 4.7 kilograms when used in combination with metformin, and reducing systolic blood pressure between 3 to 5 mmHg and reducing diastolic blood pressure approximately 2 mmHg. To date, reduction of cardiovascular events was seen specifically with empagliflozin in patients with T2DM and a history of cardiovascular disease. In the same population, empagliflozin was associated with slowing the progression of kidney disease. Moreover, patients with increased risk of cardiovascular disease treated with canagliflozin have decreased risk of death from cardiovascular causes, nonfatal MI, or nonfatal stroke. Data regarding these outcomes with dapagliflozin are underway. CONCLUSION: SGLT2 inhibitors demonstrate some positive metabolic effects. In addition, empagliflozin specifically has demonstrated reduction in cardiovascular events and delay in the progression of kidney disease in patients with T2DM and a history of cardiovascular disease. Further data is needed to assess if this is a class effect.

Combination therapies in the management of type 2 diabetes: the use of insulin degludec/liraglutide.

The global burden of type 2 diabetes is estimated to currently affect over 350 million people worldwide and is anticipated to continue increasing over the next 20 years. Current treatment guidelines recommend the choice of pharmacotherapy based upon patient-specific parameters, with combination therapy for patients with a hemoglobin A1c level ≥9%. A new combination therapy of insulin degludec + liraglutide provides a long-acting basal insulin with a glucagon-like peptide agonist. In clinical trials, this combination product has reduced hemoglobin A1c and fasting plasma glucose more than the individual agents alone. Further advantages observed with this combination include weight loss and decrease in hypoglycemia compared to basal insulin alone.

Achieving cholesterol goals with low-cost 3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors.

OBJECTIVE: The objective of this study was to determine the efficacy of widely available low-cost generic statins in achieving NCEP/ATP III cholesterol goals in diabetic patients seen in an indigent clinic. METHODS: Retrospective chart review of patients seen in the pharmacist managed diabetes clinic between January 1, 2005 and February 10, 2010. 154 patient charts were reviewed, with 12 included for analysis. Patients were age >40, diagnosed with diabetes mellitus, referred to the pharmacy clinic for diabetes management, and treated with a study statin for 6 weeks. Patients were excluded for baseline triglycerides >400 mg/dL, treatment with a non-study lipid lowering therapy ≤6 weeks prior to baseline, or pregnancy. The primary endpoint was the proportion of patients with an LDL <100 mg/dL at 6 weeks. Secondary endpoints included an LDL <70 mg/dL, other cholesterol goals, and a 30% reduction in LDL at 6 weeks. RESULTS: At the first follow-up, 33% (n = 4) of patients achieved an LDL <100 mg/dL, and 66.7% (n = 8) a 30% LDL reduction. Race was a significant predictor, with Caucasians having greater LDL reductions than non-Caucasians at 6 weeks (Pearson Correlation -0.595, p = 0.041). Higher doses were significant predictors of greater change in LDL (Pearson Correlation -0.708, p = 0.01). CONCLUSION: Due to the small sample size, statistical power was not met. Both race and dose were significant predictors of LDL reduction. When controlled for race, dose remained a significant predictor of LDL reduction. Further studies with low-cost statins in a larger patient population are needed.

Low-Molecular-Weight Heparin Prophylaxis Dosing: Is Weight an Issue?

Objective. To evaluate the pharmacokinetic, safety, and effectiveness data of dosing low-molecular-weight heparins (LMWHs) for prophylaxis of venous thromboembolic events (VTEs) in obese people. Data Sources. A PubMed search (1966 to September 2015) was performed of published English articles using the following keywords: low-molecular-weight heparin, prophylaxis, and obesity. Study Selection and Data Extraction. In all, a total of 11 articles were included in this review. The search was conducted to identify pharmacokinetic studies, clinical trials (phases I-IV), or retrospective evaluations of the impact of weight and/or obesity on anti-Xa levels as well as the safety and effectiveness of LMWHs used for VTE prophylaxis. Data Synthesis. The vast majority of the available data focus on enoxaparin. Pharmacokinetic, effectiveness, and safety data all support increased enoxaparin dosing in obese patients. However, the optimal adjustment remains uncertain. For now, we recommend using 40 mg twice daily as the data for effectiveness use this regimen. Dalteparin dosing should not be adjusted in class I-II obese (body mass index 30.0-39.9 kg/m2) patients. Data regarding the impact of class III obesity (body mass index ≥40 kg/m2) on dalteparin effectiveness is needed. Total body weight dosing of tinzaparin can be used to optimize anti-Xa levels, but safety and effectiveness data are needed before weight-based tinzaparin dosing is routine medical practice for obese patients. Conclusions. The data regarding dosing of LMWHs for VTE prophylaxis are quite limited. High-quality studies are needed to help optimize dosing for obese adults requiring LMWH prophylaxis.

Dulaglutide: an evidence-based review of its potential in the treatment of type 2 diabetes.

INTRODUCTION: As the prevalence of type 2 diabetes mellitus (T2DM) is anticipated to continue to rise worldwide, so too are the treatment options also continuing to expand. Current guidelines recommend individualized treatment plans which allow for provider choice and diversity of pharmacotherapeutic regimens. The glucagon-like peptide-1 receptor agonist (GLP-1 RA) class is rapidly expanding, with dulaglutide (Trulicity™) as a once-weekly agent recently approved. AIMS: This article examines the evidence currently available on the efficacy and safety of dulaglutide for use in T2DM. EVIDENCE REVIEW: Dulaglutide has been shown to have similar efficacy and safety to other newer GLP-1 RAs, and better glycemic control than placebo. It lowers glycated hemoglobin (A1c), fasting and postprandial glucose levels, and promotes weight loss when used as first-, second-, or third-line therapy. It has also been shown to improve ß-cell function and provide cardiovascular benefits, such as lower blood pressure and improved lipid levels. Dulaglutide also has a low risk for hypoglycemia and a similar adverse effect profile to other GLP-1 RAs in the class, with transient gastrointestinal problems and potential risk for pancreatitis. PLACE IN THERAPY: While long-term data on safety and efficacy are forthcoming, dulaglutide is positioned to be placed at the same level as other GLP-1 RAs in the class: as second-line therapy in addition to diet and exercise in those patients who cannot achieve glycemic control on monotherapy metformin. It may also be useful as first-line therapy instead of metformin. CONCLUSION: Dulaglutide is a once-weekly GLP-1 RA approved for the treatment of T2DM that has shown similar efficacy to other agents in this class.

Sodium-glucose co-transporter 2 inhibitors: evidence and place in therapy.

Type 2 diabetes effects millions of people yet remains difficult to treat with oral pharmacotherapy. Metformin is the first line recommended therapy, and current guidelines suggest individualized therapy for second line selection. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are the newest class of agents in treating type 2 diabetes via an insulin independent mechanism to lower blood glucose. Currently marketed agents, including canagliflozin, dapagliflozin, empagliflozin, and luseogliflozin, reduce hemoglobin A1c (HbA1c) ~0.8-1%, reduce fasting and post prandial glucose, and have little hypoglycemia associated with them when added to therapies including metformin, a sulfonylurea, pioglitazone, or insulin. Patients receiving SGLT-2 inhibitors have reduced weight and blood pressure, but are more susceptible to urinary tract infections and genital mycotic infections. This review summarizes current literature regarding the SGLT-2 inhibitors.

Drug treatment of type 2 diabetes mellitus in patients for whom metformin is contraindicated.

Metformin is considered an initial drug of choice for type 2 diabetes mellitus by leading recommendations. When contraindications to its use exist or patients cannot tolerate it due to adverse effects, clinicians have a variety of other classes of agents to treat hyperglycemia associated with type 2 diabetes mellitus. Each class of agent has its own benefit and safety profile. There are numerous factors to consider when selecting another agent in lieu of metformin including, but not limited to, overall efficacy in A1c reduction, adverse effect profile, cost, and patient preference. The number of factors influencing the decision process presents challenges and often no one specific agent is ideal. Each pharmacotherapeutic class of agents alternative to metformin for the treatment of hyperglycemia in type 2 diabetes mellitus as initial monotherapy is reviewed.

Saxagliptin and metformin in fixed combination for the treatment of type 2 diabetes in adults.

Type 2 diabetes affects millions of people worldwide and significantly contributes to morbidity and mortality of those affected by it. Current guidelines recommend individualized treatment regimens following first line metformin therapy. Saxagliptin, a dipeptidyl-peptidase 4 inhibitor, provides a secondary mechanism of action to decrease hyperglycemia when used in combination with metformin. The combination of metformin and saxagliptin has shown improvements in hemoglobin A1c and fasting plasma glucose in greater efficacy than when either agent is used alone. Adverse effects of combination therapy are similar to when these agents are used individually, and are rated as tolerable by patient satisfaction scores. Overall, the combination use of saxagliptin in addition to metformin is an attractive option for clinicians to use in the treatment of type 2 diabetes.

Once-weekly exenatide: an extended-duration glucagon-like peptide agonist for the treatment of type 2 diabetes mellitus.

Type 2 diabetes affects over 25 million people in the United States. There are many treatment options for patients with type 2 diabetes, but current treatments must be administered on a daily basis. Once-weekly exenatide, an extended-duration glucagon-like peptide-1 (GLP-1) agonist, provides an option for patients to take a drug weekly, with pharmacotherapeutic effects that are superior to twice-daily exenatide and sitagliptin and comparable to insulin glargine. The DURATION trials provide evidence that once-weekly exenatide reduces hemoglobin A1c , and may result in weight loss. Once-weekly exenatide is marketed as a 2-mg injection administered subcutaneously once every 7 days. Adverse effects of once-weekly exenatide include gastrointestinal effects, hypoglycemia, injection-site reactions, pancreatitis, and antibody development. Patients with a self history or family history of thyroid tumors should avoid using once-weekly exenatide. Delayed gastric absorption with orally administered drugs is possible, and monitoring should occur to avoid loss in therapeutic effect. Once-weekly exenatide is a new extended-duration agent with efficacy and tolerability profiles comparative to older therapies. Appropriate patients for once-weekly exenatide would be those who are concerned about weight gain, hypoglycemia, or those who do not wish to administer injections daily.

Removing barriers to insulin use.

Patients with type 2 diabetes and their physicians are often reluctant to begin insulin therapy--despite evidence of its efficacy. Here's help in overcoming this other form of "insulin resistance."