Glucagon-like peptide-1 receptor agonists use for type 2 diabetes mellitus in end-stage renal disease.

BACKGROUND: Management of type 2 diabetes mellitus (T2DM) in patients with end-stage renal disease (ESRD) remains a challenge given limited data. Although current guidelines recommend use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for the treatment of T2DM in patients with concomitant chronic kidney disease, supporting safety and efficacy evidence is lacking for patients with ESRD or hemodialysis. OBJECTIVE: This retrospective study was conducted to evaluate the efficacy and safety of GLP-1 RAs for the treatment of T2DM in patients with ESRD. DESIGN, SETTING, AND PARTICIPANTS: This is a single-centered, multifacility retrospective cohort analysis. Patients were included if they had a diagnosis of T2DM and ESRD and were prescribed a GLP-1 RA. Patients were excluded if the GLP-1 RA was prescribed solely for weight loss. OUTCOME MEASURES: The primary outcome was change in A1C. Secondary outcomes included (1) incidence of acute kidney injury (AKI), (2) change in weight, (3) change in estimated glomerular filtration rate, (4) ability to discontinue basal or bolus insulin, and (5) incidence of emergent hypoglycemia. RESULTS: There were 46 unique patients and 64 individual GLP-1 RA prescriptions included. The mean reduction in A1C was 0.8%. There were 10 incidences of AKI, although none occurred in the semaglutide cohort. Emergent hypoglycemia occurred in 3 patients who were all prescribed concomitant insulin. CONCLUSION: Results from this retrospective review provide additional real-world data on use of GLP-1 RAs in this unique population. Prospective studies to control for confounding factors are warranted given that GLP-1RAs are a safer alternative to insulin in this high-risk population.

Impact of a pharmacist-led outpatient telemedicine clinic on chronic obstructive pulmonary disease in a veteran population.

OBJECTIVES: The primary objective was to evaluate chronic obstructive pulmonary disease (COPD) interventions in a pharmacist-led telemedicine clinic. Secondary objectives were to quantify emergency department (ED) visits and hospitalizations for COPD exacerbations. SETTING: A single-center, outpatient telemedicine clinic within the Veterans Affairs (VA) Tennessee Valley Healthcare System from January 2021 to June 2021. PRACTICE DESCRIPTION: Patients with an active COPD diagnosis and assigned to a primary care team within the local VA were reviewed for enrollment. Visits were conducted through VA video connect or telephone. During these appointments, pertinent information was collected and pharmacotherapy and nonpharmacotherapy interventions were implemented to optimize COPD management. PRACTICE INNOVATION: Visits were conducted by a postgraduate year 2 ambulatory care pharmacy resident under supervision of a clinical pharmacy specialist with a scope of practice. Appointments were virtual to reduce coronavirus disease 2019 exposure and increase access to care. Patients were identified through a COPD patient report and provider referral to target high-risk patients. EVALUATION: Interventions made were documented at each visit. Chart review and patient interview were used to quantify ED visits or hospitalizations for COPD exacerbations occurring the year before or during clinic enrollment. RESULTS: Of 82 charts reviewed, 18 patients were eligible for enrollment. Eleven were followed as 7 patients did not show for initial visits. A total of 31 COPD interventions occurred including 13 nonpharmacotherapy (i.e., inhaler education, smoking cessation) and 18 pharmacotherapy (i.e., optimization of COPD regimens). An average of 3 COPD interventions were completed per patient followed. No ED visits and 2 hospitalizations for a COPD exacerbation occurred during the study period. This cohort had 1 ED visit and 10 hospitalizations the year before enrollment. CONCLUSION: This telemedicine clinic experience, albeit a small study population, suggests an opportunity for pharmacists to provide pharmacotherapy and nonpharmacotherapy interventions, which may improve COPD-related outcomes and access to care.