Type-2 Diabetes
Don't use DIABETES as a CV risk equivalent
As a pharmacy doctor, you will see more consensus on using statins for diabetes patients. We all know the controversy about the ACC/AHA cholesterol guidelines that abandoned LDL goals and recommended specific statin doses instead. Now the American Diabetes Association is following suit and providing similar guidance on when to use a statin in diabetes patients. …
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Type-2 Diabetes
Personalize glycemic targets for patients with diabetes
As a clinical pharmacist, people with diabetes will rely on your help to tailor A1c goals and decipher continuous glucose monitoring (CGM) metrics. Continue to emphasize individualizing glycemic goals, explain that a “one-size-fits-all” approach isn’t safe, practical, or recommended... A1c. Rely on A1c to asses…
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Statins
Think "LOWER IS BETTER" for LDL in high CV risk patients
As a cardiovascular pharmacist, there is an ongoing debate regarding the necessity of aiming for a specific LDL goal. For over a decade, the focus has been on using target DOSES of statins shown to reduce CV risk , rather than titrating to an LDL goal. But there’s been a shift toward a blended approach in recent years. Data comparing specific LDL targets are limited.…
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Type-2 Diabetes
Finerenone (Kerendia) role for Diabetic Kidney Disease
As a hospital pharmacist, you will hear about a new medication finerenone ( Kerendia ) for patients with chronic kidney disease (CKD) due to type 2 diabetes. It's the first "nonsteroidal mineralocorticoid receptor antagonist", and is approved to slow CKD progression and improve CV outcomes in these patients. Finerenone is thought to limit fibrosis and …
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Type-2 Diabetes
Optimize management of CKD in patients with diabetes
As a clinical pharmacist, you should optimize treatment of chronic kidney disease (CKD) in patients With diabetes. Patients with CKD have a much higher rate of hospitalization, especially if they have diabetes. Use a hospital stay to optimize treatment. Ensure patients are on an ACEI or ARB to manage blood pressure (BP) . Continue to us…
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Weight Loss
Explaining the role of Mounjaro for Type 2 Diabetes
As a pharmacy doctor, you will hear buzz about new injectable Mounjaro (tirzepatide), the first "twincretin" for type 2 diabetes . Think of Mounjaro as similar to a glucagon-like peptide-1 (GLP-1) agonist, BUT it’s also a glucose-dependent insulinotropic polypeptide (GIP) agonist. More twincretins are in the works. GL…
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Weight Loss
Insulin resistance is a BIG problem
Metabolic syndrome is a BIG problem and growing. It affects over 25% of adults and 4% of adolescents. It's also called "insulin resistance syndrome" or "syndrome X" or "dysmetabolic syndrome" and even has its own ICD-9 code (see table 1) . New treatment guidelines will focus even more attention on it... …
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Weight Loss
Wegovy for weight loss
As a nutrition support pharmacist, you will hear buzz about Wegovy for weight loss. It’s injectable semaglutide, the same GLP-1 agonist as injectable Ozempic or oral Rybelsus for type 2 diabetes. READ OUR NOTE, " Weight LOSS medications don't always work ". Wegovy starts at the same 0.25 mg weekly dose as Ozempic…
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Weight Loss
Dispense SAXENDA for weight loss
As a community pharmacist, you will hear about using Saxenda for weight loss. Saxenda (liraglutide) will be a new option to help tackle obesity in adolescents 12 and up, not just in adults. About 30% of Canadian kids age 5 to 17 are overweight or obese. This may lead to adulthood obesity and a higher risk of health conditions, type 2 diabetes, heart disease, sleep …
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Weight Loss
Reduce insulin if SAXENDA is used for weight loss
As a nutrition support pharmacist, you will hear more about using Saxenda for weight loss in adolescents 12 and up, not just in adults. Saxenda will be the first GLP-1 agonist for obesity, that in addition to stimulating insulin release and inhibiting glucagon secretion, slows gastric emptying and increases satiety after eating, (see our Note about Saxenda for weigh…
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SNRIs
Compare medications for DIABETIC Neuropathy
Up to 50% of patients with diabetes develop peripheral neuropathy. Tailor medication selection based on side effects, cost, whether the medication can also treat other conditions, etc. Expect trial and error... Start at low doses and titrate to effect. But set realistic expectations. In general, fewer than 1 in 3 patients will see a 50% decrease in pain with first-l…
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Type-2 Diabetes
Ensure your DIABETIC patients are on statin
Many eligible adults with diabetes aren’t on a statin . We know that statins reduce cardiovascular (CV) risk in patients with type 1 or 2 diabetes , and guidelines recommend use. Plus statin use in patients with diabetes age 40 to 75 is a common quality measure. Follow these steps... Think of statins as "automatic" for most …
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