Choice Of Pharmacotherapy Research Articles

Assessment of the impact of procurement centralization on the drug provision for patients within the High-Cost Nosology Program in the Russian Federation

Background. In the Russian Federation, patients receive expensive drugs from the federal budget funds within High-Cost Nosology (HCN) Program.Objective: to assess the impact of drug procurement centralization on the weighted average price (WAP) per 1 unit of measurement (UM) of a drug, the procurement structure within HCN Program over 5 years (2019–2023), as well as the annual volume of procurements for each nosology and the additional annual growth compared to the previous year.Material and methods. The data on public procurement within HCN Program, regional and federal drug provision programs over the specified time period have been analyzed. During the analysis of individual nosologies, 22 drugs for the treatment of 12 HCN have been considered.Results. The median value of the change of WAP per 1 UM for all drugs within HCN Program was 6.01%. Aplastic anemia was characterized by the lowest volume of procurements over 5 years, while for malignant neoplasms was the largest. The growth in procurements from year to year within nosologies varied from +1% to +661%, while a decrease was from –97% to –1%.Conclusion. The results can be used as a basis for further research related to the process of implementation of preferential drug provision, and to development of additional tools to improve the efficacy of pharmacotherapy choice for included drugs and management decisions regarding the further expansion of HCN Program.

Factors that determine patients considering medication for the disease of obesity: an IMI2 SOPHIA study.

Obesity-related problems can now be managed with effective nutritional therapy, pharmacotherapy, and surgeries that achieve >10% weight loss. Assessing patient preferences, treatment choices, and factors affecting patients can improve treatment compliance and efficacy. Our aim was to identify factors affecting patient preference and subsequent choice of pharmacotherapy among those seeking treatment for obesity-related disorders. A participatory action study using purposeful sampling recruited 33 patients with obesity complications. They were referred to specialist clinics in non-alcoholic fatty liver disease, diabetes mellitus, hypertension, and chronic kidney disease. Sixteen males and seventeen females aged 18-70 years, with BMI > 35 kg/m2 were recruited. Before the interview, participants watched a 60-minute video explaining nutritional therapy, pharmacotherapy, and surgery in equipoise. Data were collected in semi-structured interviews; Reflective thematic analysis was used. This sub study focuses only on patients who expressed specific attitudes (positive or negative) towards pharmacotherapy. Ten (30%) patients expressed a view on pharmacotherapy. Eight (24%) patients chose pharmacotherapy alone, whereas two (6%) patients chose pharmacotherapy combined with nutritional therapy. In this sub study focusing on pharmacotherapy, five themes were identified related to choosing whether or not to take medication: (1) attitudes towards pharmacotherapy, (2) attitudes toward size of obesity and its complications, (3) weighing the benefits and risks of treatment, (4) knowledge and reassurance of health professionals, and (5) costs associated with drug therapy. The primary concerns regarding pharmacotherapy for intentional weight loss were efficacy, side effects, lifelong dosing, pharmacokinetics, and cost. Providing access to information about all the pharmacotherapies and the benefits is likely to result in greater penetrance of treatment.

Development and Validation of a Machine Learning–Based Model of Mortality Risk in First-Episode Psychosis

There is an absence of mortality risk assessment tools in first-episode psychosis (FEP) that could enable personalized interventions. To examine the feasibility of machine learning (ML) in discerning mortality risk in FEP and to assess whether such risk predictions can inform pharmacotherapy choices. In this prognostic study, Swedish nationwide cohort data (from July 1, 2006, to December 31, 2021) were harnessed for model development and validation. Finnish cohort data (from January 1, 1998, to December 31, 2017) were used for external validation. Data analyses were completed between December 2022 and December 2023. Fifty-one nationwide register variables, encompassing demographics and clinical and work-related histories, were subjected to ML to predict future mortality risk. The ML model's performance was evaluated by calculating the area under the receiver operating characteristic curve (AUROC). The comparative effectiveness of pharmacotherapies in patients was assessed and was stratified by the ML model to those with predicted high mortality risk (vs low risk), using the between-individual hazard ratio (HR). The 5 most important variables were then identified and a model was retrained using these variables in the discovery sample. This study included 24 052 Swedish participants (20 000 in the discovery sample and 4052 in the validation sample) and 1490 Finnish participants (in the validation sample). Swedish participants had a mean (SD) age of 29.1 (8.1) years, 62.1% were men, and 418 died with 2 years. Finnish participants had a mean (SD) age of 29.7 (8.0) years, 61.7% were men, and 31 died within 2 years. The discovery sample achieved an AUROC of 0.71 (95% CI, 0.68-0.74) for 2-year mortality prediction. Using the 5 most important variables (ie, the top 10% [substance use comorbidities, first hospitalization duration due to FEP, male sex, prior somatic hospitalizations, and age]), the final model resulted in an AUROC of 0.70 (95% CI, 0.63-0.76) in the Swedish sample and 0.67 (95% CI, 0.56-0.78) in the Finnish sample. Individuals with predicted high mortality risk had an elevated 15-year risk in the Swedish sample (HR, 3.77 [95% CI, 2.92-4.88]) and an elevated 20-year risk in the Finnish sample (HR, 3.72 [95% CI, 2.67-5.18]). For those with predicted high mortality risk, long-acting injectable antipsychotics (HR, 0.45 [95% CI, 0.23-0.88]) and mood stabilizers (HR, 0.64 [95% CI, 0.46-0.90]) were associated with decreased mortality risk. Conversely, for those predicted to survive, only oral aripiprazole (HR, 0.38 [95% CI, 0.20-0.69]) and risperidone (HR, 0.38 [95% CI, 0.18-0.82]) were associated with decreased mortality risk. In this prognostic study, an ML-based model was developed and validated to predict mortality risk in FEP. These findings may help to develop personalized interventions to mitigate mortality risk in FEP.

Evidence-Based Guideline for the Treatment of Smoking Cessation Provided by the National Health Insurance Service in Korea.

Although major countries, such as South Korea, have developed and disseminated national smoking cessation guidelines, these efforts have been limited to developing individual societies or specialized institution-based recommendations. Therefore, evidence-based clinical guidelines are essential for developing smoking cessation interventions and promoting effective smoking cessation treatments. This guideline targets frontline clinical practitioners involved in a smoking cessation treatment support program implemented in 2015 with the support of the National Health Insurance Service. The Guideline Development Group of 10 multidisciplinary smoking cessation experts employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to review recent domestic and international research and guidelines and to determine evidence levels using the GRADE methodology. The guideline panel formulated six strong recommendations and one conditional recommendation regarding pharmacotherapy choices among general and special populations (mental disorders and chronic obstructive lung disease [COPD]). Strong recommendations favor varenicline rather than a nicotine patch or bupropion, using varenicline even if they are not ready to quit, using extended pharmacotherapy (>12 weeks) rather than standard treatment (8-12 weeks), or using pharmacotherapy for individuals with mental disorders or COPD. The conditional recommendation suggests combining varenicline with a nicotine patch instead of using varenicline alone. Aligned with the Korean Society of Medicine's clinical guideline development process, this is South Korea's first domestic smoking cessation treatment guideline that follows standardized guidelines. Primarily focusing on pharmacotherapy, it can serve as a foundation for comprehensive future smoking cessation clinical guidelines, encompassing broader treatment topics beyond medications.

Sonographically Determined Fecal Width: An Objective Indicator of Management of Bladder and Bowel Dysfunction in Children

ObjectivesTo test whether sonographically determined fecal width (SDFW) correlates with symptom improvement in a population of children with Bladder and Bowel Dysfunction (BBD) managed with Standard Urotherapy, even for those patients lacking initial bowel complaints, MethodsWe retrospectively analyzed 200 pediatric BBD patients managed with SU for at least 3 months. Self-reported symptom improvement (complete, partial, no response) following International Children’s Continence Society (ICCS) guidelines was tabulated. Patients with complex urologic diagnoses other than VUR were excluded. Pharmacotherapy choice, physical therapy (PT), UTI occurrence, and VUR status were tabulated. SDFW was recorded. Non-parametric ANOVA and parametric/non-parametric T-testing were used for analysis. ResultsPatients had a mean age of 9.5 years (4-12). 48 patients had no GI complaints at presentation. Urotherapy yielded complete, partial, and no responses in 14% (n=27), 33% (n=67), and 53% (n=106) of patients, respectively. The average SDFW for those patients with complete response (2.6cm) was smaller than the SDFW of those with a partial response (3.1cm) or no response (3.3cm) (p=0.0001). Non-compliance led to greater SDFW compared to compliant patients (3.7cm and 3.1cm respectively, p=0.0001). FW was unaffected by VUR, UTI, PT, or pharmacotherapy. ConclusionsSDFW correlates well with symptom improvement in pediatric patients managed for BBD, confirming our hypothesis. SDFW is reasonable as single objective parameter to identify successful management in patients with BBD, extending to those without bowel complaints at presentation.

Elements of artificial intelligence in a predictive personalized model of pharmacotherapy choice in patients with heart failure with mildly reduced ejection fraction of ischemic origin

Aim. To create and train a neural network (NN) of a predictive personalized model of pharmacotherapy choice in patients with heart failure with mildly reduced ejection fraction (HFmrEF) of ischemic origin.Material and methods. The study included 170 people with HFmrEF of ischemic origin, who on the background standard pharmacotherapy, received a beta-blocker (BB) or BB+mineralocorticoid receptor antagonist eplerenone (EP): bisoprolol (BIS); BIS+EP; nebivolol (NEB); NEB+EP. Patients underwent echocardiography and were analyzed for serum aldosterone (AL), tumor necrosis factor-α (TNF-α), matrix metalloproteinase 9 (MMP-9). To create the NN model, the following approximate predictive function of parameters was used: age, AL, TNF-α, MMP-9, sphericity index (SI), type of pharmacotherapy. The result of this function is a parameter vector: AL, TNF-α, MMP-9, SI and quality of life (QOL). The designed NN model is implemented in the Matlab software package for solving machine learning and Data Science problems. The NN model is represented as a connected graph and NN function. Dichotomous analysis was used to compare the effect of treatment types in pairs. For intergroup comparison of therapy, the Wilcoxon W test method. The critical significance (p) was considered <0,05.Results. As a result of model inference, the predicted clinical parameters of patients were obtained, depending on the influence of pharmacotherapy type on the levels of AL, TNF-α, MMP-9, and SI. Function approximation of the distribution was constructed. Determination coefficient R2 of approximating functions was ≥0,92. The calculated values for the BIS therapy groups were obtained; BIS+EP — 169,59, 82,30, 15,26 and 52,92; NEB — 186,42, 87,65, 16,10 and 57,22; NEB+EP — 171,17, 71,90, 14,22 and 58,68, respectively. There were following mean values in the vector of initial states (before therapy): AL, MMP-9, TNF-α, and QOL — 205,84, 174,16, 18,32, and 50,71, respectively. The greatest negative changes of AL, MMP-9, TNF-α (p<0,05) was observed in the NEP+EP group.Conclusion. In the course of the study, using artificial intelligence, a predictive model of a personalized approach to pharmacotherapy choice in patients with HFmrEF of ischemic origin was developed and trained. It has been established that NEP+EP therapy has the greatest effect.

Review on pharmacological therapies for management of gestational diabetes

The prevalence of Gestational Diabetes Mellitus (GDM) is increasing and is closely linked to numerous negative pregnancy outcomes. To mitigate these risks, early identification and management of GDM is critical. Treatment for GDM aims to maintain normal blood sugar levels and typically includes glucose monitoring, adjustments to diet, lifestyle changes, moderate physical activity, and medication as necessary. Insulin administration is generally the preferred choice for pharmacotherapy, but oral drugs such as metformin or glyburide may also be appropriate. Compared to glyburide, which has been linked to higher birth weight, neonatal hypoglycemia, raising the risk of shoulder dystocia, and necessitating a caesarean delivery, metformin is seen to be a safe first-line therapy. It should be emphasized that some expecting mothers choose complementary and alternative therapies, such as traditional herbal supplements and treatments. This review article will address present pharmacological options and considerations associated with treating GDM.

Impulsive aggression: recognition and choice of pharmacotherapy

Instrumental (controlled) aggression is observed in populations of both mentally healthy and mentally ill people. This type of aggression is not associated with any specific pathophysiological changes and cannot be considered as an independent symptom, which might be a target of pathogenetic therapy. By contrast, impulsive aggression is a paroxysm of anger, based on affectively narrowed consciousness when volition control is significantly reduced or absent. Impulsivity is different from cognate compulsivity by the loss of a stage of intellectual processing of affectively painted representations and by that the irrational attraction to action is realized involuntary, automatic. All impulsive-behavior patients are united by common pattern of neurobiological abnormalities, such as deficit of frontal inhibition of subcortical unconscious emotions and inclinations in response to relevant arousing stimuli. The results from evidence-based research, meta-analyses and Cochrane reviews of efficiency of pharmacological agents used for reduction of impulsive aggressive behavior were summarized.

Pharmacovigilance: focus on the analysis of spontaneous reports of adverse drug reactions

Objective: using the example of data for 2019–2020 in the Rostov region, to analyze the characteristics of spontaneous reports (SR) of adverse drug reactions (ADRs), as well as to assess their correlation with the individual characteristics of patients and the drugs used. Materials and methods: The object of a retrospective descriptive study was 234 SR about ADRs registered in the Rostov region in 2019-2020. Results: highest number of SR about ADRs in 2019–2020 were associated with drugs from the group "Nervous system, "Alimentary tract and inclusion metabolism" and "Antineoplastic and immunomodulators". In 2019, as well as in 2020, there was a statistically significant correlation between the indicators of the drug group and the type about ADRs, the age of the patient and the outcome of the developed ADRs. In addition, in females, a significant relationship was established between the criterion for the severity about ADRs and its outcome. Conclusions: the results obtained during the implementation of this study include the identification of common values and prerequisites for the development about ADRs in 2019 and 2020, and therefore can be taken into account when assessing a risk-based algorithm for the exclusion and emergency of identifying ADRs. This, in turn, inevitably constitutes and personalizes the choice of pharmacotherapy, balanced in terms of "efficacy-safety".

Choice of Pharmacotherapy for Heart Failure in Patients Undergoing Venom Immunotherapy

Beta-blockers (BB) and angiotensin-converting-enzyme (ACE) inhibitors are commonly used in the treatment of heart failure. It has been suggested that these medications may also aggravate anaphylactic reactions. Bee and Vespula stings are a common cause of adult anaphylaxis and venom immunotherapy (VIT) is utilized in the management of these severe allergies. In this study, we evaluated the relationship between VIT failure and the use of BBs and ACE inhibitors.

Modeling cue-exposure therapy for alcohol use disorder in rhesus monkeys: Effects of putative cognitive enhancers

BackgroundCue-exposure therapy (CET) is an effective approach for anxiety-related disorders, but its effectiveness for substance use disorders is less clear. One potential means of improving CET outcomes is to include a cognitive-enhancing pharmacotherapy. This study evaluated d-cycloserine (DCS) and RY-023, putative cognitive enhancers targeting glutamate and GABA systems, respectively, in a monkey model of CET for alcohol use disorder. MethodsMale rhesus monkeys (n = 4) underwent multiple cycles of the CET procedure. During baseline (Phase 1), monkeys self-administered an ethanol solution under a fixed-ratio schedule and limited access conditions such that every 5th response in a 3-h session resulted in 30-s access to a drinking spout and a change in ethanol-paired cue lights from white to red. Behavior then was extinguished (Phase 2) by omitting the ethanol solution yet retaining the ethanol-paired stimulus lights. Monkeys also received injections of vehicle, DCS (3 mg/kg), a partial agonist at the glycine modulatory site on glutamatergic NMDA receptors, or the α5GABAA receptor-selective inverse agonist RY-023 (0.03 or 0.3 mg/kg). Once responding declined, monkeys underwent a cue reactivity test (Phase 3), and then returned to self-administration the following day to assess reacquisition (Phase 4). ResultsThrough multiple cycles, self-administration remained stable. Compared to vehicle, DCS facilitated extinction of ethanol seeking (Phase 2) and delayed reacquisition of ethanol self-administration (Phase 4). In contrast, RY-023 facilitated extinction (Phase 2) and reduced cue reactivity (Phase 3). ConclusionsAdjunctive pharmacotherapy can improve CET outcomes, but the choice of pharmacotherapy should be dependent on the outcome of interest.

Protocol for a Pragmatic Trial of Pharmacotherapy Options Following Unsatisfactory Initial Treatment in OCD (PROCEED).

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), but a large proportion of patients do not achieve remission after an adequate SSRI trial. To the best of our knowledge, there have been no well-powered randomized controlled trials (RCTs) of sequenced pharmacotherapy using pragmatic research designs. China provides a unique context for undertaking such a trial that will recruit the largest treatment-naïve participants and systematically compare the efficacy of different sequenced pharmacotherapy.MethodsA pragmatic research design will be adopted, with n = 1,600 treatment-naïve OCD patients initially treated for sertraline for 12 weeks, and with non-remitters then randomized to 5 different augmentation or switching pharmacotherapy options for another 12 weeks. The 5 arms will include: (1) treatment with higher than usual doses of sertraline, (2) switch to fluvoxamine, (3) switch to venlafaxine, (4) augmentation with memantine, and (5) augmentation with aripiprazole.DiscussionChina is uniquely positioned to recruit sufficiently large sample sizes of treatment-naïve OCD patients to compare different pharmacotherapy options; data from the proposed trial promises to help inform current clinical practice guidelines by providing important information about optimal pharmacotherapy choice for those who demonstrate no response or response but no remission to first line pharmacotherapy.Trial RegistrationThe trail was registered on 27 August 2020 in ClinicalTrials.gov (https://register.clinicaltrials.gov/) (NCT04539951).

Emerging Pharmacological Treatments for Migraine in the Pediatric Population.

Headaches in children and adolescents have high incidence and prevalence rates, with consequent elevated disability costs to individuals and the community. Pediatric migraine is a disorder with substantial clinical differences compared to the adult form. Few clinical trials have been performed specifically on primary headache in pediatric populations using acute and preventative treatments, often with conflicting findings. The limited high-quality data on the effectiveness of treatments are also due to the high placebo effect, in terms of reductions in both the frequency and intensity of migraine attacks in the pediatric population. The recent introduction of calcitonin gene-related peptide (CGRP) pathway inhibitors and ditans is changing the treatment of migraine, but the majority of the data are still limited to adulthood. Thus, few drugs have indications for migraine treatment in the pediatric age group, and limited evidence gives guidance as to the choice of pharmacotherapy. Herein, we review the current evidence of pharmacological treatments and ongoing clinical trials on acute and preventative treatments in the pediatric population with migraine.

Genetic Risk Factors for Adverse Drug Reactions

The use of medicines may in some cases be associated with the development of drug-induced diseases (DIDs) аnd other adverse drug reactions (ADRs), which leads to an increase in morbidity/mortality rates, and/or symptoms forcing a patient to seek medical attention or resulting in hospitalisation. ADRs may develop due to changes in a patient’s genotype, which entail an inadequate pharmacological response. The aim of the study was to analyse and summarise literature data on genetic risk factors that cause DIDs аnd other ADRs. It was shown that the polymorphism of genes encoding enzymes of drug metabolism (CYP, UGT, NAT, TPMT, EPHX, GST, etc.) or carriers (transporters) of drugs (P-gp, BCRP, MRP, OATP, OCT, etc.) can change the pharmacokinetics of drugs, affecting their activity. Polymorphism of RYR1, CACNA1S, MT-RNR1, VKORC1, and other genes encoding receptors targeted by drugs, and human leukocyte antigen (HLA) gene, may affect drug pharmacodynamics by modifying drug targets or changing the sensitivity of biological pathways to pharmacological effects of medicines. Changes in drug pharmacokinetics and pharmacodynamics may cause DIDs аnd other ADRs. The use of pharmacogenetic tests will allow a personalised approach to patients’ treatment and prevention or timely detection of potential ADRs during therapy. Before prescribing some medicines, clinicians should use recommendations on their dosing based on pharmacogenetic tests, which are posted on the official websites of Pharmacogenomics Research Network (PGRN), Pharmacogenomics Knowledgebase (PharmGKB), and Clinical Pharmacogenetics Implementation Consortium (CPIC). The results of ongoing clinical studies on the effect of gene polymorphism on drug safety will soon allow for higher personalisation of the choice of pharmacotherapy and prevention of many ADRs, including DIDs.

Personalized Type 2 Diabetes Management: An Update on Recent Advances and Recommendations.

Previous guidelines for the treatment of people with type 2 diabetes mellitus (T2D) have relied heavily upon rigid algorithms for the sequential addition of pharmacotherapies to achieve target glycemic control. More recent guidelines advocate a personalized approach for diabetes treatment, to improve patient satisfaction, quality of life, medication adherence and overall health outcomes. Clinicians should work with patients to develop personalized goals for their treatment, including targeted glycemic control, weight management, prevention and treatment of associated comorbidities and avoidance of complications such as hypoglycemia. Factors that affect the intensity of treatment and choice of pharmacotherapy should include medical and patient influences. Medical considerations include the diabetes phenotype, biomarkers including genetic tests, and the presence of comorbidities such as cardiovascular, renal, or hepatic disease. Patient factors include their treatment preference, age and life expectancy, diabetes duration, hypoglycemia fear and unawareness, psychological and social circumstances. The use of a personalized approach in the management of people with T2D can reduce the cost and failure associated with the algorithmic “one-size-fits-all” approach, to anticipate disease progression, improve the response to diabetes pharmacotherapy and reduce the incidence of diabetes-associated complications. Ultimately, the use of personalized medicine in people with T2D should improve medication adherence, patient satisfaction and quality of life to reduce diabetes distress and improve physical health outcomes.

Psychiatric management of Patients in intensive care units.

Psychiatric management of Patients in intensive care units.

Nowoczesne leczenie pacjentów z nadciśnieniem tętniczym i przewlekłym zespołem wieńcowym

Approximately 1,2 billion people worldwide suffer from arterial hypertension. Among these patients, less than half receive effective treatment. Poor blood pressure control contributes to the development of complications such as stroke or coronary artery disease. A patient with such complications automatically becomes a patient at very high cardiovascular risk, and thus requires personalized and effective treatment, not only of hypertension, but also of its complications. Despite the advancement of the disease, lifestyle modification and correct choice of pharmacotherapy can protect the patient from developing heart failure and prevent acute cardiovascular events.

The main directions and prospects in polycystic ovary syndrome treatment

The article is devoted to the actual gynecological problem of women of reproductive age-polycystic ovarian syndrome (PCOS) and the possibilities of its pharmacotherapy. Difficulties in choosing the treatment of the disease are the need to take into account all clinical manifestations, not limited to menstrual disorders and infertility. PCOS is usually accompanied by hirsutism, obesity, decreased glucose tolerance, and other manifestations in various organ systems associated with metabolic disorders. These manifestations significantly reduce the quality of life of patients and also require pharmacological correction. Currently, the first line of drugs in the treatment of PCOS remains combined oral contraceptives, which have been used by women for decades, but, unfortunately, have multiple adverse reactions. The latter is the reason for the search for other methods of pharmacotherapy that are highly effective and safe. Metformin is one these glucose-lowering drugs, which shows effectiveness in the treatment of PCOS. Drugs from such groups as glucagon-like peptide-1 receptor agonists are at the research stage, and the development of treatment tactics using glucose-lowering drugs that have antagonism to glucagon is continuing. Expanding the choice of pharmacotherapy, thanks to the search for new, more effective and safe drugs and combining it with other treatment methods, makes it possible to control PCOS taking into account the individual characteristics of patients.

Changing patterns in medication prescription for gestational diabetes during a time of guideline change in the USA: a cross-sectional study.

To define patterns of prescription and factors associated with choice of pharmacotherapy for gestational diabetes mellitus (GDM), namely metformin, glyburide and insulin, during a period of evolving professional guidelines. Cross-sectional study. US commercial insurance beneficiaries from Market-Scan (late 2015 to 2018). We included women with GDM, singleton gestations, 15-51years of age on pharmacotherapy. The exposure was pharmacy claims for metformin, glyburide and insulin. Pharmacotherapy for GDM with either oral agent, metformin or glyburide, compared with insulin as the reference, and secondarily, consequent treatment modification (addition and/or change) to metformin, glyburide or insulin. Among 37762 women with GDM, we analysed data from 10407 (28%) with pharmacotherapy, 21% with metformin (n=2147), 48% with glyburide (n=4984) and 31% with insulin (n=3276). From late 2015 to 2018, metformin use increased from 17 to 29%, as did insulin use from 26 to 44%, whereas glyburide use decreased from 58 to 27%. By 2018, insulin was the most common pharmacotherapy for GDM; metformin was more likely to be prescribed by 9% compared with late 2015/16, but glyburide was less likely by 45%. Treatment modification occurred in 20% of women prescribed metformin compared with 2% with insulin and 8% with glyburide. Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for GDM among a privately insured US population during a time of evolving professional guidelines. Further evaluation of the relative effectiveness and safety of metformin compared with insulin is needed. Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for gestational diabetes mellitus in the USA.

Prescribing of SGLT2 inhibitors in primary care: A qualitative study of General Practitioners and Endocrinologists

AimsTo explore: 1) General Practitioners’ (GPs’) perspectives regarding initiating SGLT2 inhibitors and the resources that inform their pharmacotherapy choices; and 2) The support provided to GPs by Endocrinologists in relation to the prescription of type 2 diabetes medications. MethodsSemi-structured interviews with 15 GPs and 12 Endocrinologists working in diverse areas in New South Wales, Australia. Interviews were recorded, transcribed, and emergent themes were identified using a general inductive approach. ResultsUnder-appreciation of the cardio-renal benefits of SGLT2 inhibitors, a preference for an Endocrinologist to initiate therapy, and patients’ experiences with adverse effects were identified as reasons for low rates of initiating SGLT2 inhibitors by some GPs. GPs reported that they would like to receive education about this topic from Endocrinologists, ideally via case-based discussions. A perceived challenge faced by Endocrinologists in providing GP education included potential constraints on talk content imposed by industry at sponsored events. Endocrinologists indicated that interactive sessions were most useful to GPs. ConclusionsDespite the evidence for the cardio-renal benefits of SGLT2 inhibitors, there are barriers to GPs prescribing these agents. Case-based discussions between GPs and Endocrinologists about type 2 diabetes treatment including the role of SGLT2 inhibitors could overcome some of these barriers.