Saxagliptin and sitagliptin in adult patients with type 2 diabetes: a systematic review and meta-analysis.

The objective of this study is to compare the efficacy and safety of sitagliptin and saxagliptin with placebo and other hypoglycaemic medications in adults with type 2 diabetes. We searched MEDLINE®, Embase, the Cochrane Library and the International Pharmaceuticals from their inception through 3 February 2011. Studies were included of adults with type 2 diabetes that were 12 weeks or more in duration. Meta-analyses were conducted when included studies were homogenous enough to justify combining their results. A total of 32 articles met inclusion criteria. Sitagliptin 100 mg monotherapy and saxagliptin 5 mg resulted in greater HbA1c reduction compared to placebo [weighted mean difference (WMD) -0.82%, 95% CI -0.95 to -0.70 and WMD -0.70, 95% CI -0.84 to -0.56, respectively]. Sitagliptin was similar to sulfonylureas for HbA1c reduction (WMD 0.08%, 95% CI 0-0.16, 3 trials) and to saxagliptin in one head-to-head trial. There was no statistically significant difference in hypoglycaemia between sitagliptin (pooled RR 1.55, 95% CI 0.55-4.36) or saxagliptin (pooled RR 1.04, 95% CI 0.28-3.81) and placebo. Sitagliptin and saxagliptin result in similar modest HbA1c reductions and do not increase the risk of hypoglycaemia unless combined with other therapies. Their role in the long-term treatment of type 2 diabetes remains unclear given the lack of long-term data on efficacy, harms and health outcomes.

Pharmacist management of patients with diabetes mellitus enrolled in a rural free clinic.

PURPOSE: The impact of pharmacist management of patients with diabetes mellitus enrolled in a rural free clinic was evaluated. METHODS: Data from 95 patients continuously enrolled in a new pharmacist service were analyzed over 24 months. Patients were at least 18 years old, qualified for free care on the basis of income or insurance status, and had a diagnosis of type 2 diabetes mellitus upon clinic entry. Under a collaborative agreement, pharmacists educated patients on diabetes, counseled patients on lifestyle modifications, assessed appropriateness of drug therapy, and managed drug therapy for diabetes and associated comorbid conditions. Clinical impact was measured by changes from baseline glycosylated hemoglobin (HbA(1c)) levels, blood pressure, and lipid levels over a 24-month period. Using published cost estimates, the economic impact of the clinic was calculated based on expected savings for each patient who had a decrease of ≥1% in HbA(1c) value. RESULTS: Significant reductions from baseline in HbA1c values (p < 0.0001), systolic blood pressure (p = 0.0011), diastolic blood pressure (p = 0.0015), low-density-lipoprotein cholesterol (p < 0.0001), and triglyceride levels (p = 0.0001) were achieved in clinic patients. Based on an expected savings of $1,118 per patient who had a decrease of >1% in HbA(1c) value (n = 67), the pharmacist service was estimated to provide a savings of $74,906 per year. CONCLUSION: Pharmacist management of patients with type 2 diabetes significantly influenced clinical and economic outcomes in an uninsured population living in a rural area with few health care resources.

Clinical outcomes of antimicrobial lock solutions used in a treatment modality: a retrospective case series analysis.

BACKGROUND: Antimicrobial lock therapy (ALT) may be considered as adjunctive therapy in the treatment of catheter-related bloodstream infections (CRBSI) when catheter removal is not a favorable option. OBJECTIVE: To evaluate the outcomes associated with ALT as adjunctive treatment of CRBSI. METHODS: This was a 24-month retrospective case series analysis evaluating patients treated for more than 24 hours with ALT. The primary outcome was blood culture sterilization for 30 days posttherapy. The impact of ALT duration and time to initiation on central venous catheter (CVC) salvage were evaluated. Logistic regression modeled the association between ALT and sterilization rates, with a prespecified level of significance (α) of 0.1. RESULTS: Twenty-six cases were included in data analysis. Patients included ranged from 5 months to 82 years of age; 77% of patients were receiving total parenteral nutrition or chemotherapy. The majority of patients received vancomycin, daptomycin, or gentamicin combined with heparin in a lock solution. Blood culture sterilization was achieved in 69.2% of cases, and sterilization plus CVC retention was achieved in 11 cases (42.3%). Longer durations of ALT (≥9 days) were significantly correlated with blood culture sterilization (odds ratio = 1.367, P = 0.077). CONCLUSION: ALT used as an adjunct to systemic therapy for adequate duration in CRBSI can achieve CVC sterilization and retainment without subsequent infectious complications.

Evaluation of a pharmacist-managed lipid clinic that uses point-of-care lipid testing.

BACKGROUND: Hyperlipidemia is a significant, modifiable risk factor for developing coronary heart disease. Low-density lipoprotein cholesterol (LDL-C) goal achievement has improved overall, but many high-risk patients remain above the desired LDL-C goals. Published data have demonstrated the ability of pharmacist-managed lipid clinics to improve lipid management in a variety of clinical settings. OBJECTIVE: This observational analysis aimed to report the impact of a newly developed hospital-based, outpatient lipid clinic by the use of point-of-care testing on LDL-C goal attainment. METHODS: A retrospective, observational analysis was conducted from February 2007 to December 2008. The primary outcome measure was the change in the proportion of patients who achieved their LDL-C goal at the end of the observation period compared with baseline. RESULTS: A total of 81 patients met study inclusion criteria. Mean duration of follow-up was 9.0 ± 4.9 (SD) months. At the end of the observation period, 82.9% of patients achieved their LDL-C goal compared with 55.3% at baseline (P < .0001). The mean LDL-C decreased from 103 ± 45 mg/dL at baseline to 82 ± 28 mg/dL at the end of the observation period (P < .0001). CONCLUSION: An outpatient hospital-based, pharmacist-managed lipid clinic improved LDL-C goal attainment. Our results are unique in that pharmacists used point-of-care testing to obtain lipid results for making therapy adjustments during the face-to-face visit.