Bulletin Today
APhA Staff
An NIH-backed study shows that the diabetes treatments insulin glargine and liraglutide more effectively maintain target blood glucose levels than sitagliptin or glimepiride when added to first-line metformin.
Clinicians typically prescribe metformin, along with exercise and diet modifications, as initial treatment for diabetes, but it is generally understood that more than one medication will be needed over time.
What the best options are for long-term diabetes management have yet to be determined. The randomized GRADE trial published September 22, 2022, in two papers in the New England Journal of Medicine dug into this question by examining 4 common interventions and their effects in an ethnically and racially diverse population of more than 5,000 patients with type 2 diabetes.
Liraglutide or insulin glargine plus metformin kept blood glucose levels within range for the longest period. However, almost 75% of study participants overall failed to stay on target over 4 years.
“GRADE effectively shows which drugs worked best at achieving and maintaining blood glucose targets over time, but we need to establish even more effective strategies for the long-term maintenance of acceptable glucose levels,” said study chair David M. Nathan, director of the Massachusetts General Hospital Diabetes Center. “We still have more work to do, such as evaluating other interventions and treatment combinations to help people with type 2 diabetes achieve long-term glucose control.”
SGLT-2 inhibitors that are now available were excluded from the GRADE study because they were not FDA-approved in 2013, when the clinical trial was launched. ■
APhA, NASPA release more findings from pharmacy workplace and well-being report
The latest findings from the Pharmacy Workplace and Well-being Reporting (PWWR) initiative, which was launched by APhA and the National Alliance of State Pharmacy Associations (NASPA) last fall, are now available.
According to Ilisa BG Bernstein, PharmD, JD, FAPhA, APhA’s interim executive vice president and CEO, the most recent submissions reflect a continued theme of threatening or abusive behaviors leveled against pharmacy staff by customers and coworkers.
PWWR reviewed 173 anonymous reports on pharmacy workplace experiences during the reporting cycle covering mid-January 2022 through mid-August 2022.
NASPA’s executive vice president and CEO, Rebecca Snead, RPh, FAPhA, said the trend represents a call to action for the profession to address the problem.
The other major takeaway from the new analysis concerns the breakdown in communication between pharmacy staffers and upper management, which is leading to more workers feeling like their voice is not being heard.
The 2022 PWWR results were not all negative, however. Positive submissions highlighted improved work–life balance, changes in pharmacy operating hours, and workflow systems for enhanced efficiency and patient safety, to name a few. ■
Michigan pharmacists receive clarity on authority to prescribe contraceptives
The Michigan Department of Licensing and Regulatory Affairs (LARA) has released a new interpretation of the Michigan Public Health Code to enable pharmacists to partner with physicians so that the pharmacists directly dispense hormonal birth control.
Michigan pharmacists have historically had the authority to prescribe hormonal contraceptives under collaborative practice agreements, but a recent announcement from Michigan Governor Gretchen Whitmer brings greater public awareness to this service provided by pharmacists. Two Michigan House bills in the state’s legislature will give pharmacists the authority to prescribe hormonal contraceptives according to rules developed by the Michigan Department of Health and Human Services and the Michigan Board of Pharmacy.
LARA’s interpretation allows only physicians with Doctor of Medicine or Doctor of Osteopathy degrees licensed in Michigan to be eligible delegates. They can grant pharmacists with a PharmD degree who are licensed in the state the authority to prescribe birth control.
Participating pharmacists must also complete training about hormonal contraceptives and agree to “adequate supervision by the delegating licensee.” The interpretive statement from LARA does not require pharmacists to prescribe hormonal contraception if they do not wish to do so.
Twenty other states and Washington, DC, have implemented regulations that allow pharmacists to prescribe birth control, according to the National Alliance of State Pharmacy Associations. ■
SARS-CoV-2’s spike protein seems to linger in body of patients with long COVID
A study by researchers at Harvard has identified the presence of SARS-CoV-2’s spike protein in the blood of patients with long COVID up to 1 year after infection, but not in people who fully recovered from the disease.
The study, published September 2, 2022, in Clinical Infectious Diseases, involved 37 patients with long COVID and 26 patients in a control group. According to the researchers, the findings indicate that lingering clusters of the virus may be activating the immune system in some people, resulting in inflammation, blood clots, and other complications.
Several physicians and researchers are working together to examine the viral persistence associated with long COVID and hope to raise $100 million to develop treatments. Called the Long COVID Research Initiative (LCRI), the group is run by the PolyBio Research Foundation, a nonprofit group based in Mercer Island, WA, that specializes in complex chronic inflammatory diseases. LCRI says it has received a pledge of $15 million from Balvi, an investment and direct giving fund. ■
USPSTF recommends anxiety screening for all adults under 65
The U.S. Preventive Services Task Force (USPSTF) has released draft recommendations calling for all adult medical patients younger than age 65 years to undergo screening for anxiety.
Although the advisory panel launched work on the guidance before the COVID-19 pandemic began, the tremendous stress borne by Americans during the public health emergency helped shape the recommendations.
Lori Pbert, USPSTF member and a clinical psychologist and professor at the University of Massachusetts Chan Medical School, told the New York Times that grief over the loss of friends and family members who succumbed to COVID-19 and fear of getting sick, along with rising crime rates and inflation, are some of the reasons behind the emotional crisis brewing in the United States.
The USPSTF task force, which made a similar case earlier this year for children and adolescents to undergo anxiety checks, accepted public comment on the adult guidance through October. ■
Number of states with high rates of adult obesity more than doubles
New CDC data show that 19 states and 2 territories have at least 35% of residents with adult obesity. That figure is more than two times the number of states with high adult obesity prevalence recorded in 2018.
CDC noted the 2021 Adult Obesity Prevalence Maps draw attention to disparities in obesity across states and across racial and ethnic populations.
“This report illustrates the urgent need for making obesity prevention and treatment accessible to all Americans in every state and every community,” said CDC Acting Principal Deputy Director Debra Houry, MD, MPH. “When we provide stigma-free support to adults living with obesity, we can help save lives and reduce severe outcomes of disease.”
The 19 states and 2 territories are: Alabama, Arkansas, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, West Virginia, Puerto Rico, and the U.S. Virgin Islands. ■