Effect of Oral Semaglutide Compared with Placebo and Subcutaneous Semaglutide on Glycemic Control in Patients with Type 2 Diabetes

Julia Lvovich, Mercer University College of Pharmacy

Worldwide, type II diabetes affects 9% of male population and 7.9% of female population. [1] It has been shown that genetics, lifestyle, and environment factors can predispose adults and children to develop insulin resistance that leads to increased glucose levels in the blood. Overtime, prolonged exposure to high blood glucose levels causes damage to blood vessels and increases risk for coronary artery disease, kidney disease, and obstructive sleep apnea. [2] Treatment of type II diabetes can be targeted with lifestyle modifications (e.g. weight and diet management, exercise) and pharmacotherapy. When considering pharmacotherapy agents, the choices depend on the desired lower blood glucose hemoglobin A1C (HbA1C) reduction, weight gain/loss properties, and other comorbidities. [1]

Glucagon-like peptide -1 (GLP-1) receptor agonists are incretin mimetics and lower HbA1C level by 0.5-1.5%. [3] These drugs also possess weight loss property, which provides an added benefit in type II diabetic patients. However, they are only available in injection formulations due to degradation of the peptides by stomach acid. [4] To overcome the pharmacological limitation, an oral GLP-1 receptor agonist was co-formulated with an absorption enhancer, which increases the local pH to prevent the degradation in the stomach. The efficacy and safety of the new drug, semaglutide, has been evaluated in a phase II trial, which is summarized below.

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Efficacy and Safety of Alirocumab in Insulin-treated Diabetics with High Cardiovascular Risk

Kayla Peltier, Mercer University College of Pharmacy

In 2015, the Centers for Disease Control and Prevention (CDC) estimates that 23.0 million Americans were living with diabetes and 7.2 million of Americans had undiagnosed diabetes. [1]

Diabetes is a risk factor for atherosclerotic cardiovascular disease (ASCVD), and the National Lipid Association (NLA) guidelines classify patients with diabetes as high-to-very-high-risk for developing ASCVD. [2] Due to the concern, the most current lipid guidelines from the American College of Cardiology (AHA)/American Heart Association (AHA) and the American Diabetes Association (ADA) standards of care recommend that patients aged 40 to 75 years with diabetes be started on moderate-intensity statin therapy for primary prevention of ASCVD. [3,4] The NLA guidelines recommend that diabetic patients receive either moderate- or high-intensity statin therapy, regardless of patient age. [2]

Alirocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin kexin type 9 (PCSK9) and is indicated for the treatment of heterozygous familial hypercholesterolemia or clinical ASCVD in addition to lifestyle modifications and maximally tolerated statin therapy in adults who require additional LDL-C lowering. [5] Concerns have been raised about the safety and efficacy of PCSK9 inhibitors in addition to the use of insulin therapy in diabetic patients. Therefore, this study aimed to investigate the efficacy and safety of alirocumab in patients with diabetes mellitus. [6] Continue reading

Rebranding: The Solution to Veggie Consumption?

Derek Ebot-Akoachere, Mercer University College of Pharmacy

 

An estimated 396 million adults in the world were found to be obese in 2005. This may increase to 1.12 billion in 2030 if current trends remain unabated. [1] The Food and Drug Administration is fighting to curb this health issue by food labeling and education campaigns. [2] People tend to rate foods they perceive as healthy to be less tasty [3] because they are labeled with less appealing descriptors, [4] which may render health-focused labeling counter-effective. This begs the question: what if healthy foods were labeled with more appealing descriptors?

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Weight Loss, is it Worth the Cost?

Meron Mezgebe, Mercer University College of Pharmacy

The estimated global incidence of diabetes is predicted to increase to 439 million adults by 2030 partially due to increasing prevalence of obesity and sedentary lifestyle. Diabetes may lead to premature death and complications such as blindness, amputations, renal disease, and cardiovascular diseases. [1] In the U.S., Type 2 Diabetes (T2D) costs the economy over $245 billion yearly. [2] Gastric band (GB) surgery for obese people with T2D was previously found to be cost-effective and clinically effective compared with non-surgical interventions. [3]

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Cost-Benefit Analysis of Appointment-Based Medication Synchronization in the Community Pharmacy

Qaashif Panjwani, Mercer University College of Pharmacy

The U.S. healthcare system incurred a cost of approximately $2.7 trillion in 2010, which accounted for nearly 17.9% of the gross domestic product. Of the total healthcare expenditure, nearly 30% has been identified as wasteful expense such as hospitalization due to medication non-adherence. Non-adherence to medications is suggested to lead to billions of dollars in avoidable direct medical costs. [1]

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Novel glucose-sensing technology, tight blood-glucose control, and hypoglycemia

Ben Uphouse, Mercer University College of Pharmacy

According to the American Diabetes Association (ADA), tight blood glucose control is defined as maintaining a level as close to normal (nondiabetic) as possible.  Specifically, this means aiming for blood glucose (BG) levels between 70 – 130 mg/dL before meals, less than 180 mg/dL after a meal, and a glycated hemoglobin (A1C) of less than 7%. [1] Tight control is stated to be advantageous for diabetics because it delays onset of macrovascular and microvascular diabetic complications. [2] However, according to the American Diabetes Association (ADA), tight BG levels may be difficult to maintain due to two major problems: potential for hypoglycemia and weight gain. [3]

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Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes

Caitlin Higgins, Mercer University College of Pharmacy

Jardiance® (empagliflozin) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (T2DM).  According to the package insert, empagliflozin should not be initiated if glomerular filtration rate (GFR) is below 45 mL/min/1.73 meters squared (m2).  Empagliflozin is contraindicated in patients with severe renal impairment, end-stage renal disease, or those receiving dialysis. [1]

A review article discusses the role of SGLT2 inhibitors, in which the drug class mechanism of action was stated to improve glucose control by increasing urinary glucose excretion.  The SGLT2 inhibitors were suggested to be most effective under normal circumstances, in which the adult kidney filters about 180 grams of glucose per day; it is noted that effectiveness is decreased in the presence of renal dysfunction. [2]

According to Diabetes Care, it was suggested that if an A1C target is not achieved after approximately three months, a combination of metformin and one of the following six treatment options should be initiated: sulfonylurea, thiazolidinedione, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, or basal insulin. Patient preferences, as well as various patient, disease, and drug characteristics were suggested to guide drug choice. [3]

A review of the management of hyperglycemia in T2DM states that metformin is placed as a first line therapy and it can lower glycated hemoglobin (A1C) values by 1% to 1.5% and was suggested to cause weight loss. [4]

Currently, the SGLT2 inhibitors lower A1C by 0.5% to 1%, depending on the agent and the dosage used.  The drug class is associated with modest reductions in weight (-1.5 to -3.5 kg) and systolic blood pressure (-3 to -5 mmHg).  The SGLT2 inhibitors were suggested to be best suited for obese or hypertensive patients. [2]

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