New Therapies for Patients with Type 2 Diabetes

Diabetes mellitus is a growing health problem in the United States. According to a recent CDC report, as of 2015, 30.3 million Americans (9.4% of the US population) have diabetes. Of these, 90% to 95% are diagnosed with type 2 diabetes (T2D). This number will likely continue to grow, because an estimated 84.1 million Americans have pre-diabetes, putting them at increased risk of T2D development. The manufacturers of the novel combination therapies that enter the market each year hope to simplify medication regimens for patients with T2D and to improve their adherence. Select combination products that were approved in the last few years for T2D are listed in Table 1

Management of Acne Vulgaris

About 50 million people in the Unites States have acne vulgaris (AV) (figure1), a common inflammatory skin disease that predominantly affects adolescents and young adults. Although it can occur in any age group, AV affects about 85% of teenagers. The prevalence of acne in adult women is about 12%. Although acne is not associated with mortality, it does pose a physical and psychological burden to the patient, which may result in depression, negative body image, stress, and anxiety. The direct cost of the disease is estimated to exceed $3 billion per year. Therefore, it is imperative that clinicians are familiar with the management of AV, which consists of topical therapies, systemic antibiotics, hormonal agents, and isotretinoin. A treatment algorithm for the management of AV in adolescents and young adults is outlined in the table

Does Long-Term Proton Pump Inhibitor Use Pump Up Your Risk of Adverse Effects?

Many studies have linked proton pump inhibitor (PPI) use to several adverse effects including Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fractures, and nutritional deficiencies.1 Other reports have linked PPI use with chronic kidney disease, cognitive decline, myocardial infarction (MI), stroke, and even death.1,2,3 Many patients take PPIs chronically and may be concerned about the risk of these side effects. This poses a challenge for healthcare providers as safety data has been primarily based on retrospective and observational studies. Thus, the fears associated with long term PPI therapy can create confusion, result in extended patient visits, and lead to under-prescribing PPIs in circumstances when their use is appropriate

Back-to-School Immunizations

Further, in 2012, more than 41,000 pertussis cases and 18 deaths due to pertussis were reported to the CDC, also the largest number of cases in the United States since 1959.2 Most vaccine-preventable diseases are contagious and can be serious in children and adults with whom they have contact. Therefore, it is important that school-aged children are up-to-date on all annual immunizations prior to each school year

What’s the Big Deal about Statins?

Statins are a group of cholesterol-lowering medications that have been shown evidence to be beneficial for tens of millions of Americans. Some examples of statin medications you may have heard of include: atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), pravastatin (Pravachol) and lovastatin (Mevacor). Statins are one of the most commonly prescribed medications in the United States. One in four adults over the age of 45 years old are currently taking a statin for its many benefits. See below for more information about its use

Drug Interactions with Antimalarial Medications in Older Travelers: A Clinical Guide

Increasingly older adults are traveling to international destinations with malaria as a present risk. Surveillance systems indicate that older adults are more likely to suffer severe complications from malaria. The role of health care providers in selecting an appropriate medication for chemoprophylaxis or treatment of malaria in adults becomes more difficult as older adults undergo physiologic changes that alter the pharmacokinetic and pharmacodynamic nature of medications potentially causing increased drug interactions, adverse events, and altered drug action. A comprehensive literature search from 1970 to present, with a focus on the last 10 years, was conducted on drug interactions, pharmacokinetic and pharmacodynamic effects on antimalarials in adults. It was determined that due to pharmacodynamic and pharmacokinetic changes in older adults, especially renal and cardiovascular, special attention should be given to this population of travelers in order to minimize the likelihood of adverse events or altered drug efficacy. Antimalarial-disease interactions in older adults can occur more often due to QT prolongation, exacerbation of hypoglycemia, decreased renal elimination, and decreased hepatic metabolism. Older antimalarials have well documented drug-drug interactions. Tafenoquine, a new antimalarial, requires G6PD screening like primaquine and monitoring of new potential drug interaction with MATE1 and OCT2 substrates. While drug-drug interactions in older travelers may occur more often as a result of poly-pharmacy, data does not indicate adverse reactions or decreased drug efficacy is greater compared with younger adults. Overall, with the exception of recently approved tafenoquine, much is known about antimalarial drug and disease interactions, but new drugs are always being approved, requiring travel health providers to understand the pharmacokinetics and pharmacodynamics of antimalarial drugs to predict the impact on safety and efficacy in travelers. This guide provides travel health providers with valuable insights on potential outcomes associated with drug interactions in adults and recommended monitoring or drug regimen modification

Addressing the Crisis: Leveraging the United Nations Sustainable Development Goals to Prepare Student Leaders to Tackle the Opioid Epidemic

The United States faces several ongoing public health issues including the opioid epidemic. This article describes a new model aimed at providing a framework that incorporates the United Nations (UN) Sustainable Development Goals (SDGs) to develop pharmacy student leaders through education, experiences, and development of critical skills. This holistic approach can serve as an example methodology to equip future leaders across public health domains to tackle many of the critical problems we face today

Efficacy and Renal Outcomes of SGLT2 Inhibitors in Patients with Type 2 Diabetes and Chronic Kidney Disease

Objective: To review glucose-lowering efficacy and changes in renal function associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors among patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Data sources: A literature search of MEDLINE and Cochrane databases was performed from 2000 to August 2018 using search terms: SGLT2 inhibitors, sodium glucose co-transporter 2, canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and chronic kidney disease. References of identified articles were also reviewed. Study selection and data extraction: English-language studies investigating glucose-lowering endpoints and/or changes in renal function with one of four U.S. approved SGLT2 inhibitors were included. A total of 10 studies met inclusion criteria and are included in this review. Results: In patients with T2DM and CKD, SGLT2 inhibitors are modestly effective in lowering hemoglobin A1C and fasting plasma glucose compared to placebo. Small reductions in eGFR are seen shortly after initiating therapy with SGLT2 inhibitors, but return to baseline levels after discontinuation. SGLT2 inhibitors are associated with a substantial reduction in albuminuria and reduced risk of progression to albuminuria. Conclusions: In patients with T2DM and CKD, SGLT2 inhibitors have a decreased glucose-lowering effect compared to patients without CKD. Renal benefits among patients with CKD are similar to those without CKD and include a significant reduction in albuminuria and reduced incidence of worsening albuminuria. Given that CKD and T2DM are both associated with increased cardiovascular risk, we believe these agents should considered as preferred add-on agents in most patients with uncontrolled T2DM and eGFR \u3e30 ml/min/1.73 m2. Ongoing studies will provide additional information as to whether these agents should be added to the current standard of care for CKD patients, with and without T2DM

Effects of GLP-1 Receptor Agonists on Cardiovascular Outcomes in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Aim To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). Materials and Methods We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157). Results A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1-RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) \u3c60 ml/min/1.73 m2. Treatment with GLP1-RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59–1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1-RA in reducing cardiovascular end points. Conclusions Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1-RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1-RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1-RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk