Abstract
The American Diabetes Association recommends that patients with type II diabetes and atherosclerotic cardiovascular disease be prescribed an SGLT-2 inhibitor or GLP-1 agonist for cardioprotective benefit. This project assessed the use of these medications in this patient population in a rural clinic by measuring prescribing rates of SGLT-2/GLP-1 therapy before and after pharmacist interventions. Of the 60 patients identified at baseline, 39.39% (13/33) managed by a pharmacist were prescribed SGLT-2/GLP-1 therapy compared to the 14.81% (4/27) who had not seen a pharmacist (p = 0.025). Of the 43 patients that were not on SGLT-2/GLP-1 therapy at baseline, 13 were lost to follow-up and 13 had contraindications. For the 17 remaining patients, pharmacists recommended initiating SGLT-2/GLP-1 therapy and were able to successfully initiate therapy for 9 patients (52.94%). Pharmacist interventions improved the prescription rates from a baseline of 36.17% (17/47) to 55.3% (26/47) (p = 0.002), with SGLT-2/GLP-1 therapy contraindicated in 27.66% (13/47) of patients. This suggests that patients managed by a pharmacist have medication regimens that were optimized at a greater rate and pharmacists can have a positive impact on the appropriate medication usage in this population.
Highlights
Diabetes mellitus is a chronic condition characterized by persistently elevated blood glucose levels [1]
atherosclerotic cardiovascular disease (ASCVD), which is defined as coronary heart disease (CHD), cerebrovascular disease or peripheral artery disease of atherosclerotic origin, is associated with type II diabetes, the exact pathophysiology of how the condition increases the possibility of atherosclerosis is not known [1,4]
Type II diabetes commonly occurs in individuals with metabolic syndrome, which is a combination of abdominal obesity, hypertension, hyperlipidemia, and increased coagulability, which can increase the risk of ASCVD [4]
Summary
Diabetes mellitus is a chronic condition characterized by persistently elevated blood glucose levels [1]. Chronic hyperglycemia in type II diabetes can result in microvascular and macrovascular complications. Microvascular complications include diabetic retinopathy, nephropathy and neuropathy, while macrovascular complications include coronary artery disease, peripheral artery disease, myocardial infarction, and stroke [4]. Macrovascular complications are a grave concern, as the leading cause of morbidity and mortality in those with type II diabetes is atherosclerotic cardiovascular disease (ASCVD) [1]. ASCVD, which is defined as coronary heart disease (CHD), cerebrovascular disease or peripheral artery disease of atherosclerotic origin, is associated with type II diabetes, the exact pathophysiology of how the condition increases the possibility of atherosclerosis is not known [1,4]. Type II diabetes commonly occurs in individuals with metabolic syndrome, which is a combination of abdominal obesity, hypertension, hyperlipidemia, and increased coagulability, which can increase the risk of ASCVD [4]
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