Bulletin Today
The American College of Cardiology (ACC) released updated guidance on using diabetes medications to reduce cardiovascular risk for people who have type 2 diabetes.
Based on new data, ACC recommends that health care providers consider initiating sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs) with the goal of reducing cardiovascular risk for these patients.
Specifically, the new document provides treatment algorithms for SGLT2 inhibitors and GLP-1RAs that clinicians can use with established risk-factor modification guidelines to prevent major adverse cardiovascular events in people who have type 2 diabetes, said ACC in a news release.
Authors of the new recommendations suggest that adults with type 2 diabetes who also have atherosclerotic cardiovascular disease—or are at high risk for it—should start an SGLT2 inhibitor or GLP-1 receptor in conjunction with preventive measures such as lifestyle changes and blood pressure and lipid management. The same goes for adults with heart failure or diabetic kidney disease.
According to ACC, the recommendations should be applied in the context of guideline-directed diabetes care and are “intended to facilitate clinical decision-making,” they said in the statement.
The “2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes” was published in the Journal of the American College of Cardiology and updates the expert consensus decision pathway that ACC released in 2018.
One in three Americans would not get COVID-19 vaccine, poll says
A recent Gallup poll found that many Americans might be reluctant to receive a COVID-19 vaccine, even if the vaccine were FDA approved and available at no cost. Specifically, 35% of Americans would not get a free, FDA-approved vaccine if it were available today, according to the poll released in August.
The poll also found that Republicans were less inclined than Democrats to be vaccinated. Additionally, 4 in 10 non-white Americans would not get a vaccine against the coronavirus.
Kathryn Edwards, MD, scientific director of the Vanderbilt Vaccine Research Program, said in a Wall Street Journal article that people may be concerned that safety was sacrificed to accelerate the vaccines’ development. FDA has said that any COVID-19 vaccine must be at least 50% more effective than a placebo in preventing the disease, a benchmark commonly used for influenza vaccines. Edwards and other researchers said awareness and education campaigns should target the millions of Americans who are not necessarily opposed to vaccines, but who also are not fully supportive of them either.
CDC scales National Diabetes Prevention Program to more pharmacies
CDC launched a multiyear effort to scale the National Diabetes Prevention Program (DPP) in more pharmacies. Many pharmacies care for patients at risk for type 2 diabetes and play a key role in CDC’s public–private National DPP, according to CDC.
CDC officials established relationships with seven pharmacies already implementing the National DPP’s lifestyle change program. Five of those pharmacies serve rural populations, and four focus on low-income or medically underserved patients.
Through interviews, CDC officials found that several of the pharmacies aligned their DPP program with wellness services they were already providing, along with sufficient financial and staffing support and preexisting relationships in their communities.
CDC’s analysis also found that pharmacists are increasingly working as providers and expanding their portfolio of patient care services. Independent pharmacies more than other pharmacy types exist in areas with a high prevalence of diabetes, although their limited resource capacity presents a hurdle to scalability, according to CDC. Nationwide pharmacy associations are strong advocates for encouraging pharmacists to offer more services and can serve as influencers in pharmacist decision making, the officials concluded.
The findings were reported in CDC’s journal, Preventing Chronic Disease.
NSAIDs should be used as first-line therapy for acute musculoskeletal pain, groups say
A new guideline from the American College of Physicians and the American Academy of Family Physicians calls for topical NSAIDs to be used as a first-line treatment for acute pain lasting no more than 4 weeks from non–low back, musculoskeletal injuries.
Based on the most up-to-date evidence about benefits and harms, the guideline recommends topical NSAIDs with or without methanol gel. Data show that topical NSAIDs not only improve pain for these types of injuries, but also physical function and treatment satisfaction for patients. The guideline, published in Annals of Internal Medicine, includes these additional recommendations as well:
- Oral NSAIDs to improve pain and physical function, or oral acetaminophen to alleviate pain
- Specific acupressure to improve pain and physical function, or transcutaneous electrical nerve stimulation to reduce pain
- Opioids, including tramadol, to treat such pain
The guideline does not address noninvasive treatment of low back pain. Recommendations were based on a network meta-analysis of over 200 trials with roughly 33,000 patients using the Grading of Recommendations Assessment, Development and Evaluation methodology.
California may create its own generic drug market
California might be the first state to develop its own line of generic drugs.
California’s legislature recently approved a measure that would direct the state’s top health agency to partner with one or more drug companies by January to make or distribute a broad range of generic or biosimilar drugs. The bill, SB 852, also opens the door for California to make its own generic drugs in the future.
Proponents of the measure say it is more important than ever for California to pave the way for its own market because COVID-19 has exposed gaps in the ability of public and private entities to maintain adequate supplies of drugs, medical equipment, and devices. Though it could take years to successfully bring a new California generic product to the market, the move would put the nation’s most populous state in direct competition with major generic and brand-name drug manufacturers that dominate the market.
If California Gov. Gavin Newsom signs the bill into law, the Department of Health and Human Services would have 18 months to identify a list of drugs the state could manufacture, with a report due to the Legislature by July 2022. By July the following year, the state would be required to assess whether it can manufacture its own generics and biosimilars.