Exploring the clinical pharmacist's role in improving home care for patients with diabetes.

Diabetes is a common condition among clients receiving home care services. Improved glycemic control can greatly thwart the long-term complications of diabetes. A study examining the role of a clinical pharmacist was performed in a home care agency in which 105 clients were interviewed and their respective charts reviewed with the following results: 37% were incorrectly classified as to type of diabetes, serum creatinine and HbA1c values were not commonly recorded, and clients tended to have complex drug regimens with a large number of potential drug-related problems. The clinical pharmacist's potential impact in this environment is great based on the data gathered from this study.

Insulin aspart: a new rapid-acting insulin analog.

OBJECTIVE: To examine the pharmacology, therapeutics, pharmacokinetics, dosing guidelines, adverse effects, and drug interactions of insulin aspart, and summarize the clinical trials of efficacy and safety in patients with type or type 2 diabetes mellitus. DATA SOURCES: A MEDLINE database search (1985-May 2000) was performed to identify all applicable published articles and abstracts; in some cases, Novo Nordisk unpublished information was also obtained. Review articles on insulin analogs were also identified, as well as review chapters in medical textbooks. STUDY SELECTION: The majority of the studies identified were in abstract form. These studies reported information on the pharmacokinetics of insulin aspart in healthy volunteers and in those with diabetes, as well as the therapeutic utility, safety, and clinical efficacy in patients with diabetes. A limited number of randomized studies were reported as artices in the medical literature DATA EXTRACTION: All published clinical studies were reviewed. DATA SYNTHESIS: Insulin aspart, the second Food and Drug Administration-approved rapid-acting insulin analog, is produced by recombinant technology that replaces the proline at position 28 on the B chain of insulin with negatively charged aspartic acid. Insulin aspart exists as hexamers that rapidly dissociate into monomers and dimers on subcutaneous injection. When administered immediately prior to a meal, insulin aspart is at least as effective as regular human insulin in control of postprandial blood glucose concentrations. Insulin aspart achieves higher peak insulin concentrations in less time and with a shorter duration of action than regular human insulin. CONCLUSIONS: Insulin aspart is a convenient premeal insulin for use by patients requiring mealtime insulin. Furthermore, due to favorable pharmacokinetics, insulin aspart controls postprandial blood glucose concentrations at least as well as regular human insulin and contributes to improved quality of life.

Creating a "win-win" home care agency-university partnership.

This article describes the experiences of the home care agency-university partnership, identifies cooperative activities and resultant clinical and cost outcomes, and cites future collaborative plans. The authors also outline home care agency and university characteristics that contribute to successful partnerships and tips for initiating such relationships.

Depression in community-dwelling elders. Overcoming treatment obstacles with new antidepressants.

Although depression is the most common psychiatric disorder among older adults, it continues to be misdiagnosed and undertreated in this population for a variety of reasons. The authors present an overview of the efficacy and side effects of antidepressant medications, pointing out advantages of new drugs that are especially important in older patients.