iForumRx.org

Reason for Visit:  Referred by primary care provider to pharmacy services for education and management; diabetes not responding to oral therapy.

Guest Authors: Jillian Cerullo, PharmD and Michelle Gauvin, PharmD, BCACP, BCGP, CDCES

Expert Panelists: Jennifer Trujillo, PharmD, BCPS, CDCES, BC-ADM and Joshua Neumiller, PharmD, CDCES

Music by Good Talk

The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were recently updated with a focus on kidney health in patients with diabetes.  The updated guidelines include recommendations on screening, prevention, and treatment of chronic kidney disease (CKD), including the use of SGLT2 inhibitors, finerenone, and ACE inhibitors or ARBs.  The written commentary posted on the iForumRx website provides a succinct summary of the Top Ten Things Every Clinician Should Know.

Guest Authors:  Kara Olstad, PharmD; Gurminder Sanghera, BSc, PharmD; and Darren Grabe, PharmD

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The cost of diabetes in the United States has nearly doubled over the past decade in part due to rising prices and the cost of newer medications used to manage the disease.  With new, improved, but costly alternatives available, it’s going to be challenging for ambulatory care practitioners to evaluate if the potential benefits of using these newer medication classes as first-line therapy (instead of metformin) outweigh their big price tag.

Guest Authors:  Amanda Smith, PharmD and Nicole Slater, PharmD, BCACP

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The 2022 AHA/ACC/HFSA Heart Failure Guidelines is a much-needed update and consolidates previously published recommendations. In the written commentary we describe the top ten things every clinician should know about the 2022 AHA/ACC/HFSA Heart Failure Guidelines.  This podcast episode highlights some of the key recommendations from the guidelines and addresses some of the practical implications.

Guest Authors:  Madison Yates, PharmD and Megan Supple, PharmD, BCACP, CPP

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Although guideline-directed medical therapy substantially improves morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF), treatments that clearly improve outcomes in those with HF and an EF >40% remain elusive. Unfortunately, the incidence and prevalence of HF are expected to substantially increase in the coming decades.  More evidence and effective treatments for those with HF with preserved ejection fraction are clearly needed.  Enter the EMPEROR-Preserved trial.

Guest Authors:  Gabrielle Givens, PharmD, BCPS and Robert Parker, PharmD

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We now have “diabetes medications” to treat heart failure with reduced ejection practice (HFrEF). Many clinicians have not yet used a sodium-glucose transporter 2 inhibitor (SGLT2i) for the treatment of HF and are (rightfully) concerned about potential drug-drug interactions, particularly when using an SGTL2i with a mineralocorticoid (MRA). A recent secondary analysis using data from the EMPEROR-Reduced study may provide some reassurance.

Guest Authors:  B. Blake Miller, PharmD, BCPS and Jennifer Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

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The prevalence of heart failure in patients with diabetes is four times higher than in the general population.  Likewise, chronic kidney disease (CKD) and diabetes are common morbidities. As new drug classes emerge in the management of diabetes and heart failure and CKD, it is important to thoroughly evaluate available literature and identify opportunities to reduce complications and costs. Sotagliflozin is a first-in-class dual SGLT-1 and 2 inhibitor approved in Europe.  Does it improve outcomes in patients with heart failure or CKD?

Guest Authors:  Maren Richards Brinton, PharmD and Jonathan C. Hughes, PharmD, BCPS, BCACP

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Until now, only two classes of medications have been definitively shown to delay the decline in renal function in patients with CKD: angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).  The sodium glucose co-transporter 2 inhibitors are increasingly prescribed to a wider and wider population of patients. And the latest data suggest they may have an important role in the treatment of chronic kidney disease (CKD) in patients with ... or without ... diabetes. 

Guest Authors:  Stefanie C. Nigro, PharmD, BCACP and Jennifer N. Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

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Patients with diabetes are 10 times more likely to experience lower limb amputations than the general population and amputations have very significant morbidity, mortality, and financial implications. While common risk factors for amputation in patients with diabetes include poor glycemic control, diabetic peripheral neuropathy, or peripheral arterial disease, canagliflozin use was implicated in the CANVAS and CANVAS-R trials. However, the CANVAS Program trials were not specifically designed to evaluate the risk of lower-extremity amputations.  Clearly, we need more information about the magnitude of risk when canagliflozin is used widely in a general population and who is at most risk.

Guest Authors:  Julie Dally, PharmD, BCPS, BCACP and Amanda Schartel, PharmD, BCACP

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Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality. Current guidelines recommend a renin-angiotensin inhibitor, beta-blocker, and aldosterone antagonist to reduce morbidity and mortality in these patients. Despite the use of multiple drug classes, 5-year mortality rates hover near 50% in patients with heart failure (HF). Despite the numerous medications available, mortality and the risk of HF hospitalizations remains high. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) have been shown to reduce HF hospitalizations in patients with diabetes. Could this medication class be useful for HF treatment even in patients without diabetes?

Guest Authors:  John Andraos, PharmD; Alexa Zeiger, PharmD; and Michael S. Kelly, PharmD, BCACP

Music by Good Talk