In an interview with Pharmacy Periods® at the American Modern society of Health and fitness-Procedure Pharmacists Summer Conferences and Exhibition, Katherine Harte, PharmD, a PGY2 ambulatory treatment pharmacy resident at the Rhode Island Clinic in Providence, Rhode Island, discusses the affect of pharmacist administration on SGLT2 inhibitors and GLP-1 receptor agonist utilization in individuals with sort 2 diabetic issues mellitus.
She addresses the role of pharmacists in running patients on these treatment regimens and how pharmacists can assist manage any adverse consequences triggered by these drugs.
Q: How have SGLT2 inhibitors and GLP-1 receptor agonists adjusted the therapy paradigm for clients with diabetes?
Katherine Harte: The procedure paradigm for individuals with Type 2 Diabetes (T2D) has truly altered in just the previous few yrs in regard to the use of SGLT2 inhibitors and GLP-1 receptor agonists. Even just a couple years back, they were primarily advised for people who were not at aim A1C soon after staying started off on Metformin. Nonetheless, the most recent 2022 suggestions do endorse the use of SGLT2 inhibitors and GLP-1 receptor agonists in individuals with specific comorbidities irrespective of their target hemoglobin A1C, what their current stage or baseline degree was, or their Metformin use. You can find definitely been significant variations in the cure paradigm, and the most essential issue is basically implementing these into follow, and that is a area that pharmacists can certainly participate in a massive purpose.
Q: What are the things to consider for treatment choice between these sufferers?
Katherine Harte: So that’s a further excellent dilemma. You will find a ton of distinctive things to consider for picking out which agent to benefit from, and most likely the most relevant is on the lookout at the comorbidities that the client has. The 3 that I believe of mostly would be heart failure, chronic kidney ailment (CKD), and ASCVD.
In phrases of coronary heart failure, normally what we arrive at for is a single of the SGLT2 inhibitors, primarily empagliflozin, or dapagliflozin. Due to the fact they do have indications for equally coronary heart failure and T2D.
For CKD, yet again, SGLT2 inhibitors are utilized preferentially but can take into account the use of GLP-1 receptor agonist as very well.
Then finally, for clients who have ASCVD, both SGLT2 inhibitors and GLP-1 receptor agonists can be utilized, but you want to be focusing on the ones that have the most knowledge at the rear of them. So people would be empagliflozin, canagliflozin, and then in terms of the GLP-1 receptor agonist, these would be dulaglutide, liraglutide, and subcutaneous semaglutide.
I imagine that type of summarizes some of the most essential points, but as always, it is really critical to look at contraindications for the remedies or renal dosing cutoffs, for case in point, and then making positive to integrate all of these into observe. Relating to us as pharmacists, if we have a collaborative observe agreement, building sure that all of these issues are produced into that collaborative apply agreement, and I know that is the scenario at my establishment.
Q: What is the part of pharmacists in handling patients on these remedy regimens for diabetic issues?
Katherine Harte: That is a truly significant question due to the fact I consider we as pharmacists have a pretty significant purpose in the administration of these prescription drugs. 1 that arrives to mind is, in terms of affordability, since these drugs are all continue to brand name title only, they can be pretty pricey with significant copays, dependent on a patient’s insurance policy position.
We, as pharmacists, can definitely aid our individuals as a result of the prior authorization procedure, via aiding them use for maker guidance packages or many other approaches that we can guide them.
One more way that we can support is striving to protect against scientific inertia and genuinely advertise the use of these medications and improve their dosing and make confident that clients are on guideline directed professional medical remedy for diabetic issues. This truly actually relates well to my exploration job that I am presenting in this article at the conference for the reason that the benefits really indicated that pharmacists currently being involved in sufferers treatment in a primary treatment clinic drastically increased utilization of both equally GLP-1 receptor agonists and SGLT2 inhibitors. I assume that just demonstrates how vital it is to have pharmacists associated in the treatment of these patients.
Q: How can pharmacists assist deal with any adverse consequences brought about by these medicine?
Katherine Harte: I believe that is a fantastic problem to go with the query beforehand, due to the fact indeed, we’re interested in obtaining the people began on these prescription drugs, but you want to make certain that they can proceed on the prescription drugs. I would say a single thing that we can do is making absolutely sure to assistance them regulate all those facet effects or adverse outcomes, so providing them some ideas in phrases of SGLT2 inhibitors. They frequently lead to improved urination so acquiring some strategies to maybe limit ingestion of carbs or just generating guaranteed to just take the treatment in the morning to avoid nocturia.
On the other hand, we have the GLP-1 receptor agonist they classically have GI adverse outcomes and some tips there to enable handle that is to check out to avoid fatty or fried foodstuff, and as properly as tried using to eat lesser foods during the day.
One more spot that pharmacists can engage in a position is essentially in the choice of the prescription drugs. So going again to the GLP-1 receptor agonist, if any individual is on a shorter performing agent, then in fact switching them about to a extended performing agent is a recommendation that we generally make simply because the lengthier acting agents have a lot less GI adverse consequences. That just summarizes some of the places that pharmacists can assistance taking care of these adverse results, so not only are we assisting to increase the utilization of them, but we’re supporting sufferers stay on these pointers directed medical therapy.