Association between self-monitoring of blood glucose and glycemic control in patients with type 2 diabetes mellitus.

PURPOSE: The relationship between the self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes mellitus in a Veterans Affairs (VA) medical center was studied. METHODS: Laboratory, inpatient, outpatient, and demographic data for patients with type 2 diabetes mellitus who were seen for three years continuously or receiving their care regularly from a single Texas VA facility between October 1, 1999, and September 30, 2002, were obtained. Local pharmacy data were used to identify patients who received blood-glucosemonitoring strips. Patients were assigned to one of four mutually exclusive groups: those who did not receive monitoring strips at all, those who received strips in fiscal year (FY) 2002 only, those who received strips in FYs 2001 and 2002, and those who received strips during all three years (FYs 2000, 2001, and 2002). Frequency of monitoring and case-mix scores were measured. Nonparametric statistics were used to compare the demographic and clinical characteristics of the four groups. Robust regression was used to analyze the relationships between SMBG and glycemic control in FY 2002. RESULTS: Of the 1185 patients who received oral hypoglycemic medications during all three fiscal years, 976 patients met the criteria for inclusion in one of the four groups. There were no significant differences among the four groups in baseline hemoglobin A1c (HbA1c) values, body mass index, or case-mix scores. The Kruskal-Wallis test found no significant difference among the four groups in the number of laboratory blood glucose tests conducted, but there were significant differences in the number of HbA1c tests conducted among the groups. CONCLUSION: SMBG was not associated with glycemic control in VA patients with type 2 diabetes mellitus managed on oral hypoglycemic medications.

Fenofibrate-associated nephrotoxicity: a review of current evidence.

PURPOSE: The literature describing fenofibrate-associated nephrotoxicity was reviewed. SUMMARY: Fenofibrate-associated nephrotoxicity is an underrecognized adverse effect that is being reported with increasing frequency in the medical literature. A MEDLINE search identified articles describing fenofibrate-associated nephrotoxicity. Two retrospective chart reviews reported this adverse reaction in transplant recipients and patients with renal insufficiency. A case series of six patients noted that the adverse reaction also occurred in patients without a predisposition to renal injury. Two small prospective studies have examined fenofibrate-associated nephrotoxicity, with conflicting findings regarding the mechanism. Finally, a large retrospective review and a population-based cohort study found that patients with preexisting renal disease or taking high-dosage fenofibrate have a higher risk of developing fenofibrate-associated nephrotoxicity. Fenofibrate-associated nephrotoxicity was shown to be reversible with both discontinuation and continued use of fenofibrate, though one study found that the elevations in serum creatinine (SCr) levels were permanent in study participants. Some argue that SCr elevations described in these articles were not due to renal toxicity but may be attributed to reversible mechanisms. While several mechanisms may be biologically plausible, none of the theories have been tested in clinical trials. A possible mechanism for the increase in SCr levels may include changes in renal hemodynamics causing volume depletion and the impairment of generation of vasodilatory prostaglandins, leading to renal vasoconstriction. CONCLUSION: Fenofibrate-associated nephrotoxicity is an underrecognized adverse drug reaction. Several published reports have detailed possible etiologies; however, data detailing the true incidence of fenofibrate-associated nephrotoxicity and its associated risk factors are limited.

A mnemonic for pharmacy students to use in pharmacotherapy assessment.

OBJECTIVE: To introduce pharmacy students to a patient-centered mnemonic to aid them in remembering the most important parameters when assessing a patient's drug therapy and to determine whether use of the device improved students' clinical examination scores. DESIGN: Second-year pharmacy students were randomized to an intervention group or a control group. A 30-minute presentation on the rationale of the mnemonic and how to apply it to clinical scenarios was given to the intervention group and then a case-based multiple-choice clinical examination was administered. Students in the control group completed the same examination first and then were given the mnemonic. ASSESSMENT: Ninety-five students completed the examination. Examination scores of students in the intervention group were 6% higher than those of students in the control group (p = 0.04). A 6-question survey instrument was administered to both groups and the majority of students agreed that they would use the mnemonic when assessing patients during their upcoming practice experiences. One-hundred percent of the students stated that the mnemonic definitely or probably helped them (or would have helped them) think critically when assessing the patient cases. CONCLUSIONS: Pharmacy students who used a mnemonic device for pharmacotherapy assessment exhibited better decision-making skills and made fewer errors than students who did not use the mnemonic.

Evaluation of the incidence and risk factors for development of fenofibrate-associated nephrotoxicity.

BACKGROUND: Fenofibrate-associated nephrotoxicity has been described in two randomized controlled trials and several observational studies. However, little is known regarding its incidence and the population(s) at risk. OBJECTIVE: This study aims to quantify the incidence and identify potential risk factors for development of nephrotoxicity in patients receiving fenofibrate. METHODS: A retrospective, observational study was conducted in the South Texas Veterans Health Care System. Data were collected regarding baseline demographics, concurrent medical conditions, medications, laboratory results, and fenofibrate use. RESULTS: Within 6 months after initiation of fenofibrate in 428 patients, 115 (27%) experienced an increase in serum creatinine of ≥ 0.3 mg/dL. Any renal disease (P = .001), chronic kidney disease (P = .01), and diabetes (P = .02) were significantly more prevalent in patients with fenofibrate-associated nephrotoxicity. Patients with nephrotoxicity had significantly greater serum creatinine (1.2 [SD 0.3] vs. 1.1 mg/dL [SD 0.3], P = .0002) and lower estimated glomerular filtration rate (72 [SD 20] vs 81 mL/min/1.73 m² [SD 20], P < .0001) at baseline. These patients also had greater use of calcium channel blockers (P = .0003), furosemide (P = .02), and angiotensin-converting enzyme inhibitors (P = .02). The incidence of nephrotoxicity was significantly greater in patients initiated on high-dose versus those on low-dose fenofibrate (P = .002). In a multivariable regression model, renal disease (P = .02), high-dose fenofibrate (P = .001), and dihydropyridine calcium channel blocker use (P = .02) were determined to be independent predictors of development of increased serum creatinine on fenofibrate. CONCLUSION: This observational study suggests fenofibrate-associated nephrotoxicity occurs more frequently than previously reported, particularly in patients with renal disease and in those receiving high-dose fenofibrate or concomitant calcium channel blockers.