Study finds pharmacist intervention improved diabetes control for Hispanic patients
A new study published September 28, 2023, in JAMA Network Open found that an intervention involving patient assessments by trained pharmacists in conjunction with primary care physicians led to better glycemic control among Hispanic patients with T2D.
The patients’ blood glucose levels fell by a mean of 0.46% within a year of participating in at least one visit with a UCMyRx-trained pharmacist from a UCLA program, according to the research.
The UCMyRx program was launched in 2012 in the Los Angeles area across 38 primary care clinics. Under the program, clinical pharmacists who undergo training in motivational interviewing are integrated within primary care practices. Their functions include evaluating laboratory results and vital signs, performing medication reconciliation, and gauging medication adherence using a standardized measure.
In the study, the researchers noted a sensitivity analysis revealing that just one pharmacist intervention visit was linked with notably lower blood glucose levels. However, visits in excess of the median number of visits did not appear to have a significant effect.
The study did not identify a major difference in systolic BP change, but this co-primary endpoint measure was at a comparatively low level among study participants from the onset, with a mean of 136 mm Hg, the researchers noted.
“A pharmacist-led intervention may be a strategy for improving some outcomes among Hispanic patients with type 2 diabetes,” the researchers said. Further, they noted that economic models have predicted that a 0.4% decrease in A1C concentration would significantly reduce microvascular and macrovascular complications among patients with diabetes over 25 years, taking into account age, sex, risk factors, and preexisting complications. ■
Adult obesity prevalence remains high, prevention and treatment needed
According to the most recent population data from CDC, 22 states have an adult obesity prevalence at or above 35%, up from 19 states in 2021. In contrast, no state had an adult obesity prevalence at or above 35% a decade ago.
The 2022 Adult Obesity Prevalence Maps point to the need for population-based strategies to help individuals have access to safe areas for physical activity, healthy foods, health care services such as surgery and medication, and obesity treatment and prevention programs without stigma.
The data came from state-based, self-reported height and weight information in the Behavioral Risk Factor Surveillance System. Adults with obesity are more vulnerable to such health conditions as heart disease, stroke, T2D, certain cancers, worse COVID-19 outcomes, and mental health issues.
“Our updated maps send a clear message that additional support for obesity prevention and treatment is an urgent priority,” said Karen Hacker, MD, MPH, director of CDC’s National Center for Chronic Disease Prevention and Health Promotion in a CDC press release. “However, we know the key strategies that work include addressing the underlying social determinants of health such as access to health care, healthy and affordable food, and safe places for physical activity.” ■
Postnatal SSRI treatment could benefit both mother and child
Findings from a study published August 29, 2023, in JAMA Network Open suggest that postnatal SSRI treatment may bring benefits in the long term to not only mothers, but also their offspring.
A total of 61,000 mother and child pairs participated in the cohort study. Participating women were recruited in weeks 17 to 18 of pregnancy from 1999 to 2008 and were prospectively followed after childbirth. Data analysis was performed between December 2021 and October 2022.
Researchers found that postnatal SSRI treatment reduced the risk of postnatal depression that related to maternal mental health, relationship satisfaction, and externalizing behaviors within the child’s early years.
According to the study, 10% to 15% of women are affected with postnatal depression, which is different from postpartum depression because it’s characterized by reoccurring depressive episodes that lead to a higher display of depression in the years after childbirth. Postpartum depression occurs immediately following childbirth. Postnatal depressive episodes not only affect a mother, but also the child, and can lead to long-term partner relationship issues, as well.
SSRIs are the preferred treatment for postnatal depression compared to other antidepressants, said study authors.
They also noted that their research could provide valuable information for clinicians and women with postnatal depression to make informed treatment decisions. ■
USPSTF’s new PrEP recommendation aims for more choices, greater impact
According to a new recommendation statement published in JAMA, the U.S. Preventive Services Task Force (USPSTF) recommends that those at high risk of contracting HIV receive newer antiretroviral drug options for PrEP, including a long-acting option.
Truvada was the first medication approved for HIV prevention in 2012. In 2019, Descovy was added as a PrEP option, and the first injectable PrEP (Apretude) became available in 2022.
USPSTF recommends that sexually active adults and adolescents be considered for PrEP if they have had anal or vaginal sex in the previous 6 months and/or a sexual partner living with HIV, an STI in the past 6 months, or a history of inconsistent or no condom use as well as if they inject drugs or have a partner who injects drugs.
No PrEP medications have FDA approval for the indication of reducing the risk of acquiring HIV via injectable drug use, but CDC guidelines note that people who inject drugs are likely to benefit from PrEP with any FDA-approved PrEP medication.
Practice laws in 17 states allow pharmacists to provide patients with PrEP or PEP and, in some cases, reimbursement for these services.
The USPSTF’s new recommendation is consistent with the 2019 recommendation that clinicians offer PrEP with effective antiretroviral therapy to individuals who are at high risk of HIV infection. ■
CDC: Overdose deaths from counterfeit drugs on the rise
A new report from CDC finds that in recent years, the number of people who overdosed and died from counterfeit prescription drugs has more than doubled. From mid-2019 to the end of 2021, overdose deaths involving counterfeit drugs increased from 2% to 4.7%.
Many individuals who didn’t obtain drugs legally from pharmacies assumed they were taking oxycodone (OxyContin) or alprazolam (Xanax), according to CDC. But counterfeit drugs contain a variety of unknown substances, and in many cases are tainted with harmful levels of fentanyl.
In the majority of all overdose deaths (93%) involving counterfeit drugs, illicit fentanyl was detected. Overall, nearly 107,000 people died from drug overdoses in 2021, and early estimates for 2022 put that figure at 105,000 deaths, according to CDC.
The researchers found that counterfeit oxycodone was most prevalent in western states, while counterfeit alprazolam was found most frequently in the South. In the western states, overdose deaths from counterfeit drugs more than tripled, from 4.7% in 2019 to 14.7% as of late 2021, likely because of an increase in the illegal and counterfeit drug supply. ■
Psilocybin may be safe and effective as treatment for MDD
Results from a new study published August 31, 2023, in JAMA found that among patients with major depressive disorder (MDD), a single 25-mg dose of psilocybin led to a steady reduction in depressive symptoms and helped improve psychosocial functioning. The goal of the research was to examine the safety and efficacy of using psilocybin in patients with MDD.
The randomized, double-blind, placebo-controlled, Phase II trial was conducted at 11 research sites across the United States between December 2019 and June 2022 and was comprised of 104 adults diagnosed with MDD.
Participants received either a single 25-mg dose of psilocybin or a placebo of 100-mg dose of niacin, both administered along with psychological support. Primary and secondary outcomes were evaluated at different time points up to 43 days after dosing.
Treatment with psilocybin was associated with a notable reduction in Montgomery-Asberg Depression Rating Scale scores compared with niacin from baseline to day 8 and baseline to day 43.
In addition, psilocybin treatment reduced Sheehan Disability scores significantly compared with niacin from baseline to day 43. Additional measures showed improvements in such areas as global disease severity, self-reported depressive and anxiety symptoms, and improved quality of life. Psilocybin treatment did not lead to emotional blunting, which is an adverse effect of standard antidepressant medications.
The researchers concluded that psilocybin may be a possible intervention for MDD, as it helped reduce a variety of depressive symptoms and also improved overall functioning, anxiety symptoms, and quality of life for study participants. ■
CDC develops antibiotic policy for reducing STIs
In proposed guidance published October 2, 2023, in the Federal Register, CDC advised clinicians to offer gay and bisexual men and transgender women more access to doxycycline, a widely used tetracycline antibiotic.
As PEP, individuals could use the drug after engaging in unprotected sex to reduce their risk of contracting gonorrhea, chlamydia, or syphilis. Research studies indicate that a treatment regimen known as “doxy PEP,” consisting of a single, 200-mg dose of doxycycline taken no more than 72 hours after unprotected sex, can curb the transmission of chlamydia and syphilis by nearly 80%, and gon-
orrhea by roughly 50%.
“Doxy PEP is moving STI prevention efforts into the 21st century,” said Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, in a statement. “We need game-changing innovations to turn the STI epidemic around, and this is a major step in the right direction.”
CDC has been developing the guidance for more than a year and wants feedback on the proposed guidance within 45 days.
In the DoxyPEP trial, researchers divided men who have sex with men and transgender women into two groups, with one group receiving doxycycline following unprotected sexual activity and a second group of those who did not. Among people who did not receive the antibiotic, their STI rate was 30% per quarter. Participants in the doxycycline arm received a median of four doses of the drug over the course of a month, while some received as many as 10 doses. ■