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Kalyani RR, Allende-Vigo MZ, Antinori-Lent KJ, Close KL, Das SR, Deroze P, Edelman SV, El Sayed NA, Kerr D, Neumiller JJ, Norton A. Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement. J Clin Endocrinol Metab 2024; 109:1155-1178. [PMID: 38381587 DOI: 10.1210/clinem/dgad745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | - Sandeep R Das
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Phyllisa Deroze
- dQ&A, The Diabetes Research Company, San Francisco, CA 94117, USA
| | - Steven V Edelman
- Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego, San Diego, CA 92103, USA
| | - Nuha A El Sayed
- American Diabetes Association, Harvard Medical School, Boston, MA 02215, USA
| | - David Kerr
- Director of Digital Health, Diabetes Technology Society, Santa Barbara, CA 94010, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL 60440, USA
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2
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Neumiller JJ, St. Peter WL, Shubrook JH. Type 2 Diabetes and Chronic Kidney Disease: An Opportunity for Pharmacists to Improve Outcomes. J Clin Med 2024; 13:1367. [PMID: 38592214 PMCID: PMC10932148 DOI: 10.3390/jcm13051367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
Chronic kidney disease (CKD) is an important contributor to end-stage kidney disease, cardiovascular disease, and death in people with type 2 diabetes (T2D), but current evidence suggests that diagnosis and treatment are often not optimized. This review examines gaps in care for patients with CKD and how pharmacist interventions can mitigate these gaps. We conducted a PubMed search for published articles reporting on real-world CKD management practice and compared the findings with current recommendations. We find that adherence to guidelines on screening for CKD in patients with T2D is poor with particularly low rates of testing for albuminuria. When CKD is diagnosed, the prescription of recommended heart-kidney protective therapies is underutilized, possibly due to issues around treatment complexity and safety concerns. Cost and access are barriers to the prescription of newer therapies and treatment is dependent on racial, ethnic, and socioeconomic factors. Rates of nephrologist referrals for difficult cases are low in part due to limitations of information and communication between specialties. We believe that pharmacists can play a vital role in improving outcomes for patients with CKD and T2D and support the cost-effective use of healthcare resources through the provision of comprehensive medication management as part of a multidisciplinary team. The Advancing Kidney Health through Optimal Medication Management initiative supports the involvement of pharmacists across healthcare systems to ensure that comprehensive medication management can be optimally implemented.
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Affiliation(s)
- Joshua J. Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99210, USA
| | - Wendy L. St. Peter
- Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Jay H. Shubrook
- Department of Clinical Sciences and Community Health, Touro University California, Vallejo, CA 94592, USA;
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3
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Neumiller JJ, Alicic RZ, Tuttle KR. Optimization of guideline-directed medical therapies in patients with diabetes and chronic kidney disease. Clin Kidney J 2024; 17:sfad285. [PMID: 38213492 PMCID: PMC10783256 DOI: 10.1093/ckj/sfad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 01/13/2024] Open
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure worldwide. CKD frequently coexists with heart failure and atherosclerotic cardiovascular disease in the broader context of cardio-kidney-metabolic syndrome. Diabetes and CKD are associated with increased risk of all-cause and cardiovascular death as well as decreased quality of life. The role of metabolic and hemodynamic abnormalities has long been recognized as an important contributor to the pathogenesis and progression of CKD in diabetes, while a more recent and growing body of evidence supports activation of both systemic and local inflammation as important contributors. Current guidelines recommend therapies targeting pathomechanisms of CKD in addition to management of traditional risk factors such as hyperglycemia and hypertension. Sodium-glucose cotransporter-2 inhibitors are recommended for treatment of patients with CKD and type 2 diabetes (T2D) if eGFR is ≥20 ml/min/173 m2 on a background of renin-angiotensin system inhibition. For patients with T2D, CKD, and atherosclerotic cardiovascular disease, a glucagon-like peptide-1 receptor agonist is recommended as additional risk-based therapy. A non-steroidal mineralocorticoid receptor antagonist is also recommended as additional risk-based therapy for persistent albuminuria in patients with T2D already treated with renin-angiotensin system inhibition. Implementation of guideline-directed medical therapies is challenging in the face of rapidly accumulating knowledge, high cost of medications, and lack of infrastructure for optimal healthcare delivery. Furthermore, studies of new therapies have focused on T2D and CKD. Clinical trials are now planned to inform the role of these therapies in people with type 1 diabetes (T1D) and CKD.
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Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Nephrology Division, Kidney Research Institute, and Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
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4
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Alicic RZ, Neumiller JJ. Incretin Therapies for Patients with Type 2 Diabetes and Chronic Kidney Disease. J Clin Med 2023; 13:201. [PMID: 38202209 PMCID: PMC10779638 DOI: 10.3390/jcm13010201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Since the early 2000s, an influx of novel glucose-lowering agents has changed the therapeutic landscape for treatment of diabetes and diabetes-related complications. Glucagon-like peptide-1 (GLP-1) receptor agonists represent an important therapeutic class for the management of type 2 diabetes (T2D), demonstrating benefits beyond glycemic control, including lowering of blood pressure and body weight, and importantly, decreased risk of development of new or worsening chronic kidney disease (CKD) and reduced rates of atherosclerotic cardiovascular events. Plausible non-glycemic mechanisms that benefit the heart and kidneys with GLP-1 receptor agonists include anti-inflammatory and antioxidant effects. Further supporting their use in CKD, the glycemic benefits of GLP-1 receptor agonists are preserved in moderate-to-severe CKD. Considering current evidence, major guideline-forming organizations recommend the use of GLP-1 receptor agonists in cases of T2D and CKD, especially in those with obesity and/or in those with high cardiovascular risk or established heart disease. Evidence continues to build that supports benefits to the heart and kidneys of the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide. Ongoing outcome and mechanistic studies will continue to inform our understanding of the role of GLP-1 and dual GLP-1/GIP receptor agonists in diverse patient populations with kidney disease.
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Affiliation(s)
- Radica Z. Alicic
- Providence Medical Research Center, Providence Inland Northwest Health, 105 W. 8th Ave, Suite 250E, Spokane, WA 99204, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Joshua J. Neumiller
- Providence Medical Research Center, Providence Inland Northwest Health, 105 W. 8th Ave, Suite 250E, Spokane, WA 99204, USA
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99164, USA
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Nicholas SB, Daratha KB, Alicic RZ, Jones CR, Kornowske LM, Neumiller JJ, Fatoba ST, Kong SX, Singh R, Norris KC, Tuttle KR. Prescription of guideline-directed medical therapies in patients with diabetes and chronic kidney disease from the CURE-CKD Registry, 2019-2020. Diabetes Obes Metab 2023; 25:2970-2979. [PMID: 37395334 DOI: 10.1111/dom.15194] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
AIM Guideline-directed medical therapy (GDMT) is designed to improve clinical outcomes. The study aim was to assess GDMT prescribing rates and prescribing-persistence predictors in patients with diabetes and chronic kidney disease (CKD) from the Center for Kidney Disease Research, Education, and Hope Registry. MATERIALS AND METHODS Data were obtained from adults ≥18 years old with diabetes and CKD between 1 January 2019 and 31 December 2020 (N = 39 158). Baseline and persistent (≥90 days) prescriptions for GDMT, including angiotensin converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB), sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide 1 (GLP-1) receptor agonist were assessed. RESULTS The population age (mean ± SD) was 70 ± 14 years, and 49.6% (n = 19 415) were women. Baseline estimated glomerular filtration rate (2021 CKD-Epidemiology Collaboration creatinine equation) was 57.5 ± 23.0 ml/min/1.73 m2 and urine albumin/creatinine 57.5 mg/g (31.7-158.2; median, interquartile range). Baseline and ≥90-day persistent prescribing rates, respectively, were 70.7% and 40.4% for ACE inhibitor/ARB, 6.0% and 5.0% for SGLT2 inhibitors, and 6.8% and 6.3% for GLP-1 receptor agonist (all p < .001). Patients lacking primary commercial health insurance coverage were less likely to be prescribed an ACE inhibitor/ARB [odds ratio (OR) = 0.89; 95% confidence interval (CI) 0.84-0.95; p < .001], SGLT2 inhibitor (OR 0.72; 95% CI 0.64-0.81; p < .001) or GLP-1 receptor agonist (OR 0.89; 95% CI 0.80-0.98; p = .02). GDMT prescribing rates were lower at Providence than UCLA Health. CONCLUSIONS Prescribing for GDMT was suboptimal and waned quickly in patients with diabetes and CKD. Type of primary health insurance coverage and health system were associated with GDMT prescribing.
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Affiliation(s)
- Susanne B Nicholas
- Nephrology Division, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kenn B Daratha
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
- Department of Medicine, University of Washington, Seattle, Spokane, Washington, USA
| | - Cami R Jones
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
| | - Lindsey M Kornowske
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
| | - Joshua J Neumiller
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | | | | | - Rakesh Singh
- Bayer US, LLC, Medical Affairs, Whippany, Whippany, USA
| | - Keith C Norris
- Nephrology Division, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest, Spokane, Washington, USA
- Department of Medicine, University of Washington, Seattle, Spokane, Washington, USA
- Kidney Research Institute, Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
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7
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Shubrook JH, Neumiller JJ. Optimized Management of Cardio-Renal-Metabolic (CRM) Conditions in Patients With T2D. J Fam Pract 2023; 72:S43-S48. [PMID: 37549412 DOI: 10.12788/jfp.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
LEARNING OBJECTIVES Describe cardio-renal-metabolic (CRM) conditions and their impact on health and patient-centered outcomes. Recognize current gaps in screening, risk factor management, and utilization of guideline-directed therapies in patients with CRM conditions. Select appropriate guideline-directed therapies for patients with type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease based on current guidelines and clinical evidence. Recognize the importance of multidisciplinary care when managing patients with CRM conditions.
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8
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Neumiller JJ, Brunton SA. New Paradigms for CKD Management in Patients With T2D. J Fam Pract 2023; 72:S37-S42. [PMID: 37549415 DOI: 10.12788/jfp.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
LEARNING OBJECTIVES At the end of the activity, participants will be able to: Identify the risks of kidney disease and their consequences in patients with type 2 diabetes (T2D). Appropriately screen for the presence of chronic kidney disease (CKD) in patients with T2D. Initiate evidence-based therapy to slow the progression of kidney disease in patients with T2D and CKD. Become familiar with the novel nonsteroidal mineralocorticoid receptor antagonist finerenone and its role in the treatment of patients with T2D and CKD.
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Abstract
PURPOSE OF REVIEW Diabetic kidney disease (DKD) is the leading cause of kidney failure worldwide. Development of DKD increases risks for cardiovascular events and death. Glucagon-like peptide-1 (GLP-1) receptor agonist have demonstrated improved cardiovascular and kidney outcomes in large-scale clinical trials. RECENT FINDING GLP-1 and dual GLP-1/glucose-depending insulinotropic polypeptide (GIP) receptor agonists have robust glucose-lowering efficacy with low risk of hypoglycemia even in advanced stages of DKD. Initially approved as antihyperglycemic therapies, these agents also reduce blood pressure and body weight. Cardiovascular outcome and glycemic lowering trials have reported decreased risks of development and progression of DKD and atherosclerotic cardiovascular events for GLP-1 receptor agonists. Kidney and cardiovascular protection is mediated partly, but not entirely, by lowering of glycemia, body weight, and blood pressure. Experimental data have identified modulation of the innate immune response as a biologically plausible mechanism underpinning kidney and cardiovascular effects. SUMMARY An influx of incretin-based therapies has changed the landscape of DKD treatment. GLP-1 receptor agonist use is endorsed by all major guideline forming organizations. Ongoing clinical trials and mechanistic studies with GLP-1 and dual GLP-1/GIP receptor agonists will further define the roles and pathways for these agents in the treatment of DKD.
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Affiliation(s)
- Radica Z. Alicic
- Providence Medical Research Center, Providence Inland Northwest Health
- Department of Medicine, University of Washington School of Medicine
| | - Joshua J. Neumiller
- Providence Medical Research Center, Providence Inland Northwest Health
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health
- Department of Medicine, University of Washington School of Medicine
- Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, Washington, USA
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Morales J, Dagogo-Jack S, Fonseca V, Neumiller JJ, Rosas SE. Perspectives on Chronic Kidney Disease With Type 2 Diabetes and Risk Management: Practical Viewpoints and a Paradigm Shift Using a Pillar Approach. Clin Diabetes 2023; 41:553-566. [PMID: 37849516 PMCID: PMC10577512 DOI: 10.2337/cd22-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN
| | - Vivian Fonseca
- Department of Medicine and Pharmacology, School of Medicine, Tulane University, New Orleans, LA
| | - Joshua J. Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Pullman, WA
| | - Sylvia E. Rosas
- Joslin Diabetes Center and Harvard Medical School, Boston, MA
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11
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Neumiller JJ, Munshi MN. Geriatric Syndromes in Older Adults with Diabetes. Endocrinol Metab Clin North Am 2023; 52:341-353. [PMID: 36948783 DOI: 10.1016/j.ecl.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Over one-quarter of adults ≥65 years old have diabetes in the United States. Guidelines recommend individualization of glycemic targets in older adults with diabetes as well as implementing treatment strategies that minimize risk for hypoglycemia. Patient-centered management decisions should be informed by comorbidities, the individual's capacity for self-care, and the presence of key geriatric syndromes that may impact self-management and patient safety. Key geriatric syndromes include cognitive impairment, depression, functional impairments (eg, vision, hearing, and mobility challenges), falls and fractures, polypharmacy, and urinary incontinence. Screening for geriatric syndromes in older adults is recommended to inform treatment strategies and optimize outcomes.
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Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, 412 East Spokane Falls Boulevard, Spokane, WA 99210, USA.
| | - Medha N Munshi
- Geriatric Diabetes Program, Joslin Diabetes Centre, Harvard Medical School, 1 Brookline Place, Suite 230, Brookline, MA 02445, USA
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12
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Kelepouris E, St Peter W, Neumiller JJ, Wright EE. Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. Diabetes Ther 2023:10.1007/s13300-023-01416-2. [PMID: 37209236 DOI: 10.1007/s13300-023-01416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023] Open
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.
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Affiliation(s)
- Ellie Kelepouris
- Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, PA, USA.
| | - Wendy St Peter
- University of Minnesota, Minneapolis, MN, USA
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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13
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Abstract
Chronic kidney disease (CKD) represents a particularly challenging diabetes complication. Diabetes now is responsible for half of all cases of CKD, thus making diabetes the most common cause of kidney failure worldwide. In patients with diabetes, CKD frequently coexists with heart failure and atherosclerotic cardiovascular disease, which together are associated with marked increases in the risk of cardiovascular and all-cause mortality. Fortunately, new therapeutic agents from several classes now are available with proven benefits for kidney and heart protection when used in patients with type 2 diabetes and CKD. Agents from the sodium-glucose cotransporter-2 inhibitor, glucagon-like peptide-1-receptor agonist, and nonsteroidal mineralocorticoid-receptor antagonist classes now are considered standard of care to improve kidney, heart, and overall survival outcomes in patients with type 2 diabetes. Efforts to educate health care providers on the benefits of these therapies are critically needed to help increase their utilization and improve clinical outcomes. Care decisions should be driven by a holistic view of patient priorities and goals with consideration of a multimodal therapeutic approach to maximize heart and kidney benefits.
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Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA; Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA.
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA; Department of Medicine, University of Washington School of Medicine, Seattle, WA; Nephrology Division, Kidney Research Institute, Institute of Translational Health Sciences, University of Washington, Seattle, WA
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14
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Whitley HP, Trujillo JM, Neumiller JJ. Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages. Clin Diabetes 2023; 41:467-473. [PMID: 37456085 PMCID: PMC10338283 DOI: 10.2337/cd23-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Heather P. Whitley
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, Auburn, AL
- Clinical Pharmacy Specialist, Baptist Family Medicine, Baptist Health System, Montgomery, AL
| | - Jennifer M. Trujillo
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
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15
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Herges JR, Galindo RJ, Neumiller JJ, Heien HC, Umpierrez GE, McCoy RG. Glucagon Prescribing and Costs Among U.S. Adults With Diabetes, 2011-2021. Diabetes Care 2023; 46:620-627. [PMID: 36630526 PMCID: PMC10020025 DOI: 10.2337/dc22-1564] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To characterize contemporary trends in glucagon fill rates and expenditures in a nationwide cohort of adults with diabetes overall and by key demographic and clinical characteristics. RESEARCH DESIGN AND METHODS In this retrospective cohort study, we examined 1) glucagon fill rates per 1,000 person-years and 2) patient out-of-pocket and health plan costs per filled glucagon dose among adults with diabetes included in OptumLabs Data Warehouse between 1 January 2011 and 31 March 2021. RESULTS The study population comprised 2,814,464 adults with diabetes with a mean age of 62.8 (SD 13.2) years. The overall glucagon fill rate decreased from 2.91 to 2.28 per 1,000 person-years (-22%) over the study period. In groups at high risk for severe hypoglycemia, glucagon fill rates increased from 22.46 to 36.76 per 1,000 person-years (64%) among patients with type 1 diabetes, 11.64 to 16.63 per 1,000 person-years (43%) among those treated with short-acting insulin, and 16.08 to 20.12 per 1,000 person-years (25%) among those with a history of severe hypoglycemia. White patients, women, individuals with high income, and commercially insured patients had higher glucagon fill rates compared with minority patients, males, individuals with low income, and Medicare Advantage patients, respectively. Total cost per dosing unit increased from $157.97 to $275.32 (74%) among commercial insurance beneficiaries and from $150.37 to $293.57 (95%) among Medicare Advantage beneficiaries. CONCLUSIONS Glucagon fill rates are concerningly low and declined between 2011 and 2021 but increased in appropriate subgroups with type 1 diabetes, using short-acting insulin, or with a history of severe hypoglycemia. Fill rates were disproportionately low among minority patients and individuals with low income.
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Affiliation(s)
| | | | | | - Herbert C. Heien
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | | | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN
- OptumLabs, Eden Prairie, MN
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16
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Galindo RJ, de Boer IH, Neumiller JJ, Tuttle KR. Continuous Glucose Monitoring to Optimize Management of Diabetes in Patients with Advanced CKD. Clin J Am Soc Nephrol 2023; 18:130-145. [PMID: 36719162 PMCID: PMC10101590 DOI: 10.2215/cjn.04510422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Treatment of patients with diabetes and CKD includes optimizing glycemic control using lifestyle modifications and drugs that safely control glycemia and improve clinical kidney and cardiovascular disease outcomes. However, patients with advanced CKD, defined as eGFR <30 ml/min per 1.73 m2 or kidney disease treated with dialysis, have limitations to the use of some preferred glucose-lowering medications, are often treated with insulin, and experience high rates of severe hypoglycemia. Moreover, hemoglobin A1c accuracy decreases as GFR deteriorates. Hence, there is a need for better glycemic monitoring tools. Continuous glucose monitoring allows for 24-hour glycemic monitoring to understand patterns and the effects of lifestyle and medications. Real-time continuous glucose monitoring can be used to guide the administration of insulin and noninsulin therapies. Continuous glucose monitoring can overcome the limitations of self-monitored capillary glucose testing and hemoglobin A1c and has been shown to prevent hypoglycemic excursions in some populations. More data are needed to understand whether similar benefits can be obtained for patients with diabetes and advanced CKD. This review provides an updated approach to management of glycemia in advanced CKD, focusing on the role of continuous glucose monitoring in this high-risk population.
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Affiliation(s)
- Rodolfo J. Galindo
- Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia
| | - Ian H. de Boer
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington
| | - Joshua J. Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
| | - Katherine R. Tuttle
- Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Seattle, Washington
- Providence Medical Research Center, Providence Health Care, Spokane, Washington
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17
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de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, Rosas SE, Rossing P, Bakris G. Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care 2022; 45:3075-3090. [PMID: 36189689 PMCID: PMC9870667 DOI: 10.2337/dci22-0027] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 02/05/2023]
Abstract
People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical trials support new approaches to treat diabetes and CKD. The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management. A joint group of ADA and KDIGO representatives reviewed and developed a series of consensus statements to guide clinical care from the ADA and KDIGO guidelines. The published guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management. Recommendations include comprehensive care in which pharmacotherapy that is proven to improve kidney and cardiovascular outcomes is layered on a foundation of healthy lifestyle. Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD.
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Affiliation(s)
- Ian H. de Boer
- Kidney Research Institute, University of Washington, Seattle, WA
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | | | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | | | - Sylvia E. Rosas
- Joslin Diabetes Center and Harvard Medical School, Boston, MA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Demark
- University of Copenhagen, Copenhagen, Denmark
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18
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Neumiller JJ, Lienhard FJ, Alicic RZ, Tuttle KR. Clinical Evidence and Proposed Mechanisms for Cardiovascular and Kidney Benefits from Sodium-Glucose Co-transporter-2 Inhibitors. touchREV Endocrinol 2022; 18:106-115. [PMID: 36694888 PMCID: PMC9835817 DOI: 10.17925/ee.2022.18.2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
The number of people living with type 2 diabetes (T2D) and its complications worldwide is increasing at an alarming rate. Fortunately, our understanding of the benefits of glucose-lowering agents from the sodium-glucose co-transporter-2 (SGLT2) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist classes on cardiovascular and kidney outcomes is advancing; this means we now have new options to mitigate the risks of these complications in patients with T2D. The SGLT2 inhibitors have consistently demonstrated benefits on atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) and heart failure (HF) events in dedicated outcome trials. Large guidelines groups now recommend SGLT2 inhibitors as a standard of care in patients with T2D and comorbid ASCVD, CKD and/ or HF. Evolving evidence additionally indicates kidney and HF benefits of SGLT2 inhibitors in populations without diabetes. These agents likely provide heart and kidney benefits through multiple mechanisms, as their impact on heart and kidney outcomes cannot be fully explained by their direct metabolic effects. On-going work to elucidate the beneficial mechanisms at play with SGLT2 inhibitors will help further optimize these life-saving therapies in patients with and without T2D.
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Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA,Providence Medical Research Center, Providence Health and Services, Spokane, WA, USA
| | - Fredrick J Lienhard
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Health and Services, Spokane, WA, USA,University of Washington School of Medicine, University of Washington, Spokane and Seattle, WA, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health and Services, Spokane, WA, USA,University of Washington School of Medicine, University of Washington, Spokane and Seattle, WA, USA,Nephrology Division, Kidney Research Institute, and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, WA, USA
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19
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de Boer IH, Khunti K, Sadusky T, Tuttle KR, Neumiller JJ, Rhee CM, Rosas SE, Rossing P, Bakris G. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2022; 102:974-989. [PMID: 36202661 DOI: 10.1016/j.kint.2022.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022]
Abstract
People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical trials support new approaches to treat diabetes and CKD. The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management. A joint group of ADA and KDIGO representatives reviewed and developed a series of consensus statements to guide clinical care from the ADA and KDIGO guidelines. The published guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management. Recommendations include comprehensive care in which pharmacotherapy that is proven to improve kidney and cardiovascular outcomes is layered on a foundation of healthy lifestyle. Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD.
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Affiliation(s)
- Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, Washington, USA.
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Tami Sadusky
- University of Washington, Seattle, Washington, USA
| | | | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Connie M Rhee
- University of California, Irvine, Orange, California, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Demark; University of Copenhagen, Copenhagen, Denmark
| | - George Bakris
- University of Chicago Medicine, Chicago, Illinois, USA
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20
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Tuttle KR, Jones CR, Daratha KB, Koyama AK, Nicholas SB, Alicic RZ, Duru OK, Neumiller JJ, Norris KC, Ríos Burrows N, Pavkov ME. Incidence of Chronic Kidney Disease among Adults with Diabetes, 2015-2020. N Engl J Med 2022; 387:1430-1431. [PMID: 36239650 DOI: 10.1056/nejmc2207018] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | - O Kenrik Duru
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Keith C Norris
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA
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21
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Alicic RZ, Neumiller JJ, Galindo RJ, Tuttle KR. Use of Glucose-Lowering Agents in Diabetes and CKD. Kidney Int Rep 2022; 7:2589-2607. [PMID: 36506243 PMCID: PMC9727535 DOI: 10.1016/j.ekir.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetes is the most common cause of kidney failure worldwide. Patients with diabetes and chronic kidney disease (CKD) are also at markedly higher risk of cardiovascular disease, particularly heart failure (HF), and death. Through the processes of gluconeogenesis and glucose reabsorption, the kidney plays a central role in glucose homeostasis. Insulin resistance is an early alteration observed in CKD, worsened by the frequent presence of hypertension, obesity, and ongoing chronic inflammation, and oxidative stress. Management of diabetes in moderate to severe CKD warrants special consideration because of changes in glucose and insulin homeostasis and altered metabolism of glucose-lowering therapies. Kidney failure and initiation of kidney replacement therapy by dialysis adds to management complexity by further limiting therapeutic options, and predisposing individuals to hypoglycemia and hyperglycemia. Glycemic goals should be individualized, considering CKD severity, presence of macrovascular and microvascular complications, and life expectancy. A general hemoglobin A1c (HbA1c) goal of approximately 7% may be appropriate in earlier stages of CKD, with more relaxed targets often appropriate in later stages. Use of sodium glucose cotransporter2 (SGLT2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1RAs) meaningfully improves kidney and heart outcomes for patients with diabetes and CKD, irrespective of HbA1c targets, and are now part of guideline-directed medical therapy in this high-risk population. Delivery of optimal care for patients with diabetes and CKD will require collaboration across health care specialties and disciplines.
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Affiliation(s)
- Radica Z. Alicic
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Spokane and Seattle, Washington, USA
- Correspondence: Radica Z. Alicic, Providence Medical Research Center, 105 West 8th Avenue, Suite 250E, Spokane, Washington 99204, USA.
| | - Joshua J. Neumiller
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, USA
| | - Rodolfo J. Galindo
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Spokane and Seattle, Washington, USA
- Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, Washington, USA
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22
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Shubrook JH, Neumiller JJ, Wright E. Management of chronic kidney disease in type 2 diabetes: screening, diagnosis and treatment goals, and recommendations. Postgrad Med 2021; 134:376-387. [PMID: 34817311 DOI: 10.1080/00325481.2021.2009726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) are at high risk of CKD progression and cardiovascular (CV) disease. Prevalence of CKD in patients with T2D is currently around 40% and continues to grow. The increasing number of people with CKD and T2D will ultimately have a significant impact upon health resource use and costs of care for people with T2D. Management of CKD in patients with T2D aims to preserve kidney function to reduce the risk of end-stage kidney disease, CV events, and mortality. Evidence-based recommendations for the treatment of patients with CKD and T2D are provided by several international and national organizations and recommend several lifestyle and pharmacological approaches to help prevent or delay the progression of CKD in patients with T2D. Guidelines include regular screening of patients with T2D for CKD using spot urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (at least annually and at least twice a year if UACR >300 mg/g). Additionally, assessment of vascular complications, together with interventions designed to improve glycemic control and lipid levels, maintain healthy body weight, and optimize blood pressure should be performed. Medications shown to slow progression of CKD include renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and, more recently, selective, non-steroidal mineralocorticoid receptor antagonists. This review highlights the ongoing challenges facing primary care providers in the management of CKD in patients with T2D including the consideration of comorbidities, adoption of new treatment options, and implementation of individualized care. Achieving consensus for optimal treatment of this disease is critical in providing consistent and appropriate care for all patients. Strategies to improve outcomes should also include use of clear referral criteria, use of a multi-disciplinary approach, and patient education.
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Affiliation(s)
- Jay H Shubrook
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
| | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Eugene Wright
- Performance Improvement at Charlotte Area Health Education Center, Charlotte, NC, USA
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23
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Affiliation(s)
| | | | - Rozalina G. McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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24
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Neumiller JJ, Alicic RZ, Tuttle KR. Overcoming Barriers to Implementing New Therapies for Diabetic Kidney Disease: Lessons Learned. Adv Chronic Kidney Dis 2021; 28:318-327. [PMID: 34922688 DOI: 10.1053/j.ackd.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
As a result of the growing number of patients with type 2 diabetes mellitus, the prevalence of diabetic kidney disease (DKD) has proven to be one of the fastest growing health care challenges globally. Early detection and initiation of appropriate interventions to slow the progression of DKD are impeded by low awareness of the health consequences of DKD, high complexity of care that includes the need for lifestyle modifications, difficulties with adhering to increasingly complicated medication regimens, and low acceptance and application of guideline-directed management. After 2 decades of status quo in the care of patients with DKD, recently approved glucose-lowering agents are promising to transform care by demonstrating slowed DKD disease progression and improved survival. As has been learned over the last 2 decades, multiple barriers exist to the optimal integration and utilization of new therapies to improve kidney outcomes. The health care community, professional societies, and regulatory agencies must join efforts to develop implementation strategies for increasing DKD awareness, detection, and treatment.
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25
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Neumiller JJ, Shubrook JH, Manley T, Alicic RZ, Tuttle KR. Optimizing use of SGLT2 inhibitors and other evidence-based therapies to improve outcomes in patients with type 2 diabetes and chronic kidney disease: An opportunity for pharmacists. Am J Health Syst Pharm 2021; 79:e65-e70. [PMID: 34185826 DOI: 10.1093/ajhp/zxab271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Jay H Shubrook
- Primary Care Department, Touro University, Vallejo, CA, USA
| | - Tom Manley
- National Kidney Foundation, New York, NY, USA
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Health Care, Spokane, WA, and Division of Medicine, University of Washington, Spokane and Seattle, WA, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, WA, and Division of Nephrology, Kidney Research Institute, and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, WA, USA
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26
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Yabusaki AA, McKeirnan KC, Neumiller JJ. Teaching advanced pharmacy practice experience students to be effective teachers of second-year pharmacotherapy students. Curr Pharm Teach Learn 2021; 13:678-682. [PMID: 33867064 DOI: 10.1016/j.cptl.2021.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/12/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Academic advanced pharmacy practice experiences (APPEs) are unique elective opportunities for student pharmacists to engage with and learn about academia. The purpose of this research was to determine the impact of second-year (PY2) student participation in fourth-year (PY4) academic APPE student-delivered review sessions on individual pharmacotherapy examination scores. METHODS The PY2 cohort was evaluated by comparing their performance against the class average when they did and did not attend a review session. Utilizing a t-test, we sought to determine if there was a significant change in student performance. Qualitative evaluations were also performed on the PY4 students experience during their rotation. RESULTS A total of 28 PY2 student pharmacists took a total of 140 exams during the study period. Of the 140 exams taken, 54 individual exams were taken after attending a review session created and led by PY4 student pharmacists and 86 exams were taken in the absence of attending a review session. Analysis showed that student performance on exams after attending a review session was 0.4 SD above the class average, while performance was very close to the class average at 0.05 SD above the class average when review sessions were not attended. CONCLUSIONS PY4 student pharmacists trained on an academic APPE can improve PY2 student pharmacists' pharmacotherapy exam scores. APPE students also self-reported positive learning experiences while participating in this teaching.
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Affiliation(s)
- Andrew A Yabusaki
- Howard University College of Pharmacy, 2300 4(th) St NW, Washington, DC, 20059, United States.
| | - Kimberly C McKeirnan
- Washington State University College of Pharmacy and Pharmaceutical Sciences, United States.
| | - Joshua J Neumiller
- Washington State University College of Pharmacy and Pharmaceutical Sciences, United States.
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27
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Alicic RZ, Cox EJ, Neumiller JJ, Tuttle KR. Incretin drugs in diabetic kidney disease: biological mechanisms and clinical evidence. Nat Rev Nephrol 2021; 17:227-244. [PMID: 33219281 DOI: 10.1038/s41581-020-00367-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 01/30/2023]
Abstract
As the prevalence of diabetes continues to climb, the number of individuals living with diabetic complications will reach an unprecedented magnitude. The emergence of new glucose-lowering agents - sodium-glucose cotransporter 2 inhibitors and incretin therapies - has markedly changed the treatment landscape of type 2 diabetes mellitus. In addition to effectively lowering glucose, incretin drugs, which include glucagon-like peptide 1 receptor (GLP1R) agonists and dipeptidyl peptidase 4 (DPP4) inhibitors, can also reduce blood pressure, body weight, the risk of developing or worsening chronic kidney disease and/or atherosclerotic cardiovascular events, and the risk of death. Although kidney disease events have thus far been secondary outcomes in clinical trials, an ongoing phase III trial in patients with diabetic kidney disease will test the effect of a GLP1R agonist on a primary kidney disease outcome. Experimental data have identified the modulation of innate immunity and inflammation as plausible biological mechanisms underpinning the kidney-protective effects of incretin-based agents. These drugs block the mechanisms involved in the pathogenesis of kidney damage, including the activation of resident mononuclear phagocytes, tissue infiltration by non-resident inflammatory cells, and the production of pro-inflammatory cytokines and adhesion molecules. GLP1R agonists and DPP4 inhibitors might also attenuate oxidative stress, fibrosis and cellular apoptosis in the kidney.
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Affiliation(s)
- Radica Z Alicic
- Providence Medical Research Center, Providence Health Care, Spokane, WA, USA.,Department of Medicine, University of Washington School of Medicine, Spokane and Seattle, WA, USA
| | - Emily J Cox
- Providence Medical Research Center, Providence Health Care, Spokane, WA, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, WA, USA. .,Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Spokane and Seattle, WA, USA.
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28
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Neumiller JJ, Chen G, Newsome C, Hughes S, Lazarus P, White JR. Assessment of Regular and NPH Insulin Concentration via Two Methods of Quantification: The Washington State Insulin Concentration Study (WICS). J Diabetes Sci Technol 2021; 15:324-328. [PMID: 31640422 PMCID: PMC8256080 DOI: 10.1177/1932296819883291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent reports have suggested that insulin vials purchased in community pharmacies do not meet the minimum required intact insulin concentration (≥95 U/mL) as defined by the United States Pharmacopeia. We sought to independently obtain multidose human insulin vials from a variety of community pharmacies across the state of Washington and quantitatively measure intact insulin. METHODS Sixty 10-mL vials of insulin (n = 30 regular human insulin and n = 30 neutral protamine Hagedorn insulin) were purchased and assayed. To ensure random selection of lots and supply chain sources, insulin samples were purchased on a variety of calendar dates from various pharmacy locations across Washington State, inclusive of both chain and independent pharmacies. All samples were assessed for intact insulin concentration via both Ultra Performance Liquid Chromatography coupled with UV detection (UPLC-UV) and Ultra Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS). RESULTS When considering all samples (N = 60), the mean concentration was 101.8 ± 4.4and 91.5 ± 1.9 U/mL as determined by UPLC-UV and UPLC-MS, respectively. Measured concentrations ranged from 90.0 to 108.4 U/mL when assayed by UV UPLC and 86.1 to 95.4 U/mL for UPLC-MS. CONCLUSION To our knowledge, this is the first study following the report by Carter et al that assessed human insulin concentrations by both UPLC-UV and UPLC-MS. These findings are important because they demonstrate that the results obtained from these two methods differ and that the method used must be considered when interpreting findings.
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Affiliation(s)
- Joshua J. Neumiller
- Department of Pharmacotherapy, College
of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA,
USA
- Joshua J. Neumiller, PharmD, Department of
Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington
State University, 412 East Spokane Falls Blvd, Spokane, WA 99202-2131, USA.
| | - Gang Chen
- Department of Pharmaceutical Sciences,
College of Pharmacy and Pharmaceutical Sciences, Washington State University,
Spokane, WA, USA
| | - Cheyenne Newsome
- Department of Pharmacotherapy, College
of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA,
USA
| | - Sally Hughes
- Department of Pharmacotherapy, College
of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA,
USA
| | - Philip Lazarus
- Department of Pharmaceutical Sciences,
College of Pharmacy and Pharmaceutical Sciences, Washington State University,
Spokane, WA, USA
| | - John R. White
- Department of Pharmacotherapy, College
of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA,
USA
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29
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Ta A, Neumiller JJ, Kim AP, Remsberg CM, Gothard MD. The Effect of Pharmacy Students' Attendance on Examination Performance in Two Sequential Active-Learning Pharmacotherapy Courses. Am J Pharm Educ 2020; 84:ajpe7749. [PMID: 33012791 PMCID: PMC7523669 DOI: 10.5688/ajpe7749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/28/2020] [Indexed: 06/11/2023]
Abstract
Objective. To examine the relationship between class attendance by Doctor of Pharmacy students and their performance on pharmacotherapy examinations within an active-learning classroom model. Methods. Second-year pharmacy students enrolled in a pharmacotherapy course series were included in the study (N=160). Class attendance was taken manually by members of the study team over a one-year study period (fall 2017 and spring 2018 semesters). Course attendance was not required and had no direct impact on student grades. Scores from the six competency-based examinations and overall course grades for each semester course, respectively, were then linked to class attendance records. Two additional examination attempts (retake and extended learning experience) were administered to students who did not receive a score of at least 80% on the initial exam or retake exam, respectively. Results. Class attendance was documented during 48 class sessions. Of the six examinations given each semester, students required an average of 1 retake of the examination during the fall semester and 1.5 retakes in the spring semester. A significant negative correlation was found in both courses between students missing more classes and receiving a lower final course grade. For each missed class session, there was a reduction in overall course grade of 0.18% and 0.14% in the fall and spring courses, respectively. Conclusion. Regular class attendance by pharmacy students enrolled in an active-learning pharmacotherapy curriculum was associated with higher scores on examinations. The results of this study illustrate the importance of attending active-learning sessions to attain higher examination scores. Further research is needed to determine whether class attendance is associated with students' improved ability to apply pharmacotherapy concepts.
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Affiliation(s)
- Ashley Ta
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington
| | - Joshua J. Neumiller
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington
| | - Anne P. Kim
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington
| | - Connie M. Remsberg
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington
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Neumiller JJ, Daratha KB, Alicic RZ, Short RA, Miller HM, Gregg L, Gates BJ, Corbett CF, McPherson SM, Tuttle KR. Medication use, renin-angiotensin system inhibitors, and acute care utilization after hospitalization in patients with chronic kidney disease. J Renin Angiotensin Aldosterone Syst 2020; 21:1470320320945137. [PMID: 32762427 PMCID: PMC7418245 DOI: 10.1177/1470320320945137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: The aims of this secondary analysis were to: (a) characterize medication use following hospital discharge for patients with chronic kidney disease (CKD), and (b) investigate relationships of medication use with the primary composite outcome of acute care utilization 90 days after hospitalization. Methods: The CKD-Medication Intervention Trial (CKD-MIT) enrolled acutely ill hospitalized patients with CKD stages 3–5 not dialyzed (CKD 3–5 ND). In this post hoc analysis, data for medication use were characterized, and the relationship of medication use with the primary outcome was evaluated using Cox proportional hazards models. Results: Participants were taking a mean of 12.6 (standard deviation=5.1) medications, including medications from a wide variety of medication classes. Nearly half of study participants were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB). ACE inhibitor/ARB use was associated with decreased risk of the primary outcome (hazard ratio=0.51; 95% confidence interval 0.28–0.95; p=0.03) after adjustment for baseline estimated glomerular filtration rate, age, sex, race, blood pressure, albuminuria, and potential nephrotoxin use. Conclusions: A large number, variety, and complexity of medications were used by hospitalized patients with CKD 3–5 ND. ACE inhibitor or ARB use at hospital discharge was associated with a decreased risk of 90-day acute care utilization.
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Affiliation(s)
- Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, USA
| | | | - Radica Z Alicic
- Providence Medical Research Center, Providence Health Care, USA.,Department of Medicine, University of Washington School of Medicine, USA
| | - Robert A Short
- Providence Medical Research Center, Providence Health Care, USA
| | | | - Liza Gregg
- Sacred Heart Medical Center, Providence Health Care, USA
| | - Brian J Gates
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, USA
| | | | - Sterling M McPherson
- Providence Medical Research Center, Providence Health Care, USA.,Elson S. Floyd College of Medicine, Washington State University, USA.,Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care, USA.,Department of Medicine, University of Washington School of Medicine, USA.,Nephrology Division, Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, USA
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Das SR, Everett BM, Birtcher KK, Brown JM, Januzzi JL, Kalyani RR, Kosiborod M, Magwire M, Morris PB, Neumiller JJ, Sperling LS. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2020; 76:1117-1145. [PMID: 32771263 DOI: 10.1016/j.jacc.2020.05.037] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Munshi M, Neumiller JJ. Liberalisation, deintensification, and simplification in diabetes management: words matter. Lancet Diabetes Endocrinol 2020; 8:95-97. [PMID: 31780376 DOI: 10.1016/s2213-8587(19)30379-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Medha Munshi
- Joslin Diabetes Centre, and Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA 02215, USA.
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, USA
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Affiliation(s)
- Sally Hughes
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
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Tuttle KR, Alicic RZ, Duru OK, Jones CR, Daratha KB, Nicholas SB, McPherson SM, Neumiller JJ, Bell DS, Mangione CM, Norris KC. Clinical Characteristics of and Risk Factors for Chronic Kidney Disease Among Adults and Children: An Analysis of the CURE-CKD Registry. JAMA Netw Open 2019; 2:e1918169. [PMID: 31860111 PMCID: PMC6991307 DOI: 10.1001/jamanetworkopen.2019.18169] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Chronic kidney disease (CKD) is serious and common, yet recognition and public health responses are limited. OBJECTIVE To describe clinical features of, prevalence of, major risk factors for, and care for CKD among patients treated in 2 large US health care systems. DESIGN, SETTING, AND PARTICIPANTS This cohort study collected data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) registry, an electronic health record-based registry jointly curated and sponsored by Providence St Joseph Health and the University of California, Los Angeles. Patients were adults and children with CKD (excluding end-stage kidney disease) and adults at risk of CKD (ie, with diabetes, hypertension, or prediabetes) identified by laboratory values, vital signs, prescriptions, and administrative codes. Data were collected from January 2006 through December 2017, with analyses performed from March 2019 through November 2019. EXPOSURES Diabetes, hypertension, and prediabetes. MAIN OUTCOMES AND MEASURES Clinical and demographic characteristics, prevalence, and prescribed medications. RESULTS Of 2 625 963 adults and children in the sample, 606 064 adults (23.1%) with CKD had a median (interquartile range [IQR]) age of 70 (59-81) years, with 338 785 women (55.9%) and 434 474 non-Latino white individuals (71.7%). A total of 12 591 children (0.4%) with CKD had a median (IQR) age of 6 (1-13) years, with 7079 girls (56.2%) and 6653 non-Latino white children (52.8%). Median (IQR) estimated glomerular filtration rate was 53 (41-61) mL/min/1.73 m2 among adults and 70 (50-95) mL/min/1.73 m2 in children. Prevalence rates for CKD in adults were 4.8% overall (606 064 of 12 669 700) with 1.6% (93 644 of 6 011 129) during 2006 to 2009, 5.7% (393 455 of 6 903 084) during 2010 to 2013, and 8.4% (683 574 of 8 179 860) during 2014 to 2017 (P < .001). A total of 226 693 patients (37.4%) had category 3a CKD; 100 239 (16.5%), category 3b CKD; 39 125 (6.5%), category 4 CKD; and 20 328 (3.4%), category 5 CKD. Among adults with CKD, albuminuria and proteinuria assessments were available in 52 551 (8.7%) and 25 035 (4.1%) patients, respectively. A renin-angiotensin system inhibitor was prescribed to 124 575 patients (20.6%), and 204 307 (33.7%) received nonsteroidal anti-inflammatory drugs or proton pump inhibitors. Of 1 973 258 adults (75.1%) at risk, one-quarter had diabetes or prediabetes (512 299 [26.0%]), nearly half had hypertension (955 812 [48.4%]), and one-quarter had both hypertension and diabetes or prediabetes (505 147 [25.6%]). CONCLUSIONS AND RELEVANCE This registry-based cohort study revealed a burgeoning number of patients with CKD and its major risk factors. Rates of identification and use of kidney protective agents were low, while potential nephrotoxin use was widespread, underscoring the pressing need for practice-based improvements in CKD prevention, recognition, and treatment.
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Affiliation(s)
- Katherine R. Tuttle
- Providence St Joseph Health, Providence Medical Research Center, Spokane, Washington
- University of Washington School of Medicine, Seattle
| | - Radica Z. Alicic
- Providence St Joseph Health, Providence Medical Research Center, Spokane, Washington
- University of Washington School of Medicine, Seattle
| | - O. Kenrik Duru
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Cami R. Jones
- Providence St Joseph Health, Providence Medical Research Center, Spokane, Washington
| | - Kenn B. Daratha
- Providence St Joseph Health, Providence Medical Research Center, Spokane, Washington
| | | | - Sterling M. McPherson
- Providence St Joseph Health, Providence Medical Research Center, Spokane, Washington
- University of Washington School of Medicine, Seattle
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Joshua J. Neumiller
- Providence St Joseph Health, Providence Medical Research Center, Spokane, Washington
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane
| | - Douglas S. Bell
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Carol M. Mangione
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Keith C. Norris
- Division of Nephrology, University of California, Los Angeles
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Norris KC, Duru OK, Alicic RZ, Daratha KB, Nicholas SB, McPherson SM, Bell DS, Shen JI, Jones CR, Moin T, Waterman AD, Neumiller JJ, Vargas RB, Bui AAT, Mangione CM, Tuttle KR. Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD. BMC Nephrol 2019; 20:416. [PMID: 31747918 PMCID: PMC6868861 DOI: 10.1186/s12882-019-1558-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD.
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Affiliation(s)
- Keith C Norris
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA.
- UCLA Department of Medicine, Division of General Internal Medicine, 1100 Glendon Ave. Suite 900, Los Angeles, CA, 90024, USA.
| | - O Kenrik Duru
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Radica Z Alicic
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kenn B Daratha
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Sterling M McPherson
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Douglas S Bell
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Jenny I Shen
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Cami R Jones
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Tannaz Moin
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- VA Greater Los Angeles, Los Angeles, USA
| | - Amy D Waterman
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Joshua J Neumiller
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, USA
| | - Roberto B Vargas
- Charles R. Drew University of Medicine and Science, Los Angeles, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Alex A T Bui
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Carol M Mangione
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Katherine R Tuttle
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
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Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington; and
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Neumiller JJ, Mandal B, Weeks DL, Bautista E, Gates BJ, Corbett CF. Potential Adverse Drug Events and Associated Costs During Transition from Hospital to Home. Sr Care Pharm 2019; 34:384-392. [DOI: 10.4140/tcp.n.2019.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Neumiller JJ, Kalyani RR, Herman WH, Grant RW, Wysham CH, Inzucchi SE, Hirsch IB, Fonseca VA, Buse JB, Barrett EJ. Evidence supports prediabetes treatment. Science 2019; 364:341-342. [PMID: 31023917 DOI: 10.1126/science.aax3548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA.
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - William H Herman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48105-1912, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | | | | | - Irl B Hirsch
- University of Washington Medical Center, Seattle, WA 98105, USA
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Eugene J Barrett
- Division of Endocrinology and Diabetes, University of Virginia, Charlottesville, VA 22903, USA
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Alicic RZ, Neumiller JJ, Johnson EJ, Dieter B, Tuttle KR. Erratum. Sodium-Glucose Cotransporter 2 Inhibition and Diabetic Kidney Disease. Diabetes 2019;68:248-257. Diabetes 2019; 68:1094. [PMID: 30936151 PMCID: PMC6477911 DOI: 10.2337/db19-er05a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alicic RZ, Neumiller JJ, Johnson EJ, Dieter B, Tuttle KR. Sodium-Glucose Cotransporter 2 Inhibition and Diabetic Kidney Disease. Diabetes 2019; 68:248-257. [PMID: 30665953 DOI: 10.2337/dbi18-0007] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/07/2018] [Indexed: 12/17/2022]
Abstract
Diabetic kidney disease (DKD) is now the principal cause of chronic kidney disease leading to end-stage kidney disease worldwide. As a primary contributor to the excess risk of all-cause and cardiovascular death in diabetes, DKD is a major contributor to the progressively expanding global burden of diabetes-associated morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a newer class of antihyperglycemic agents that exert glucose-lowering effects via glycosuric actions. Preclinical studies and clinical trials of SGLT2 inhibitors have consistently demonstrated reduction of albuminuria and preservation of kidney function. In particular, SGLT2 inhibitors lower risk of congestive heart failure, a major cardiovascular complication in DKD. This Perspective summarizes proposed mechanisms of action for SGLT2 inhibitors, integrates these data with results of recent cardiovascular outcomes trials, and discusses clinical applications for patients with DKD. The American Diabetes Association/European Association for the Study of Diabetes Consensus Report published online in October 2018 recommends SGLT inhibitors as preferred add-on therapy for patients with type 2 diabetes and established cardiovascular disease or chronic kidney disease, if kidney function is adequate. Results of the ongoing and just completed clinical trials conducted in patients with established DKD will facilitate further refinement of current guidelines.
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Affiliation(s)
- Radica Z Alicic
- Providence Health Care, Washington State University, Spokane, WA
- University of Washington School of Medicine, Seattle, WA
| | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - Emily J Johnson
- Providence Health Care, Washington State University, Spokane, WA
| | - Brad Dieter
- Providence Health Care, Washington State University, Spokane, WA
| | - Katherine R Tuttle
- Providence Health Care, Washington State University, Spokane, WA
- University of Washington School of Medicine, Seattle, WA
- Kidney Research Institute, University of Washington, Seattle, WA
- Institute of Translational Health Sciences, University of Washington, Seattle, WA
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Affiliation(s)
- Tory Knebel
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - Joshua J Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
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Neumiller JJ. Diabetes Spectrum: Past, Present, and Future. Diabetes Spectr 2018; 31:297-298. [PMID: 30510381 PMCID: PMC6243229 DOI: 10.2337/ds18-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
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Affiliation(s)
- Vinh Bui
- Washington State University College of Pharmacy, Spokane, WA
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Abstract
IN BRIEF Each year, the American Diabetes Association updates its Standards of Medical Care in Diabetes to inform clinicians on components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. In the 2018 Standards, recommendations related to the use of antihyperglycemic therapy in adults with type 2 diabetes were updated in consideration of new evidence published since the last iteration in 2017. This brief review summarizes key recommendations from the 2018 Standards related to the pharmacologic management of people with type 2 diabetes. In so doing, it additionally highlights drug- and patient-specific factors to consider when intensifying antihyperglycemic therapy.
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Affiliation(s)
- Joshua J. Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Umpierrez GE, Neumiller JJ. Pearls for Your Practice: A Clinician's Guide to Recently Published Guidelines and Position Statements. Diabetes Spectr 2018; 31:215-216. [PMID: 30140135 PMCID: PMC6092892 DOI: 10.2337/ds18-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tuttle KR, Alicic RZ, Short RA, Neumiller JJ, Gates BJ, Daratha KB, Barbosa-Leiker C, McPherson SM, Chaytor NS, Dieter BP, Setter SM, Corbett CF. Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial. Clin J Am Soc Nephrol 2018; 13:231-241. [PMID: 29295829 PMCID: PMC5967429 DOI: 10.2215/cjn.06790617] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES CKD is characterized by remarkably high hospitalization and readmission rates. Our study aim was to test a medication therapy management intervention to reduce subsequent acute care utilization. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The CKD Medication Intervention Trial was a single-blind (investigators), randomized clinical trial conducted at Providence Health Care in Spokane, Washington. Patients with CKD stages 3-5 not treated by dialysis who were hospitalized for acute illness were recruited. The intervention was designed to improve posthospitalization care by medication therapy management. A pharmacist delivered the intervention as a single home visit within 7 days of discharge. The intervention included these fundamental elements: comprehensive medication review, medication action plan, and a personal medication list. The primary outcome was a composite of acute care utilization (hospital readmissions and emergency department and urgent care visits) for 90 days after hospitalization. RESULTS Baseline characteristics of participants (n=141) included the following: age, 69±11 (mean±SD) years old; women, 48% (67 of 141); diabetes, 56% (79 of 141); hypertension, 83% (117 of 141); eGFR, 41±14 ml/min per 1.73 m2 (serum creatinine-based Chronic Kidney Disease Epidemiology Collaboration equation); and urine albumin-to-creatinine ratio median, 43 mg/g (interquartile range, 8-528) creatinine. The most common primary diagnoses for hospitalization were the following: cardiovascular events, 36% (51 of 141); infections, 18% (26 of 141); and kidney diseases, 12% (17 of 141). The primary outcome occurred in 32 of 72 (44%) of the medication intervention group and 28 of 69 (41%) of those in usual care (log rank P=0.72). For only hospital readmission, the rate was 19 of 72 (26%) in the medication intervention group and 18 of 69 (26%) in the usual care group (log rank P=0.95). There was no between-group difference in achievement of guideline-based goals for use of renin-angiotensin system inhibition or for BP, hemoglobin, phosphorus, or parathyroid hormone. CONCLUSIONS Acute care utilization after hospitalization was not reduced by a pharmacist-led medication therapy management intervention at the transition from hospital to home.
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Affiliation(s)
- Katherine R. Tuttle
- Providence Health Care, Nephrology Division, Kidney Research Institute, Spokane, Washington
- Institute of Translational Health Sciences and
- School of Medicine, University of Washington, Seattle, Washington
| | - Radica Z. Alicic
- Providence Health Care, Nephrology Division, Kidney Research Institute, Spokane, Washington
- School of Medicine, University of Washington, Seattle, Washington
| | - Robert A. Short
- Providence Health Care, Nephrology Division, Kidney Research Institute, Spokane, Washington
| | | | | | - Kenn B. Daratha
- Providence Health Care, Nephrology Division, Kidney Research Institute, Spokane, Washington
- Nursing, and
| | | | - Sterling M. McPherson
- Providence Health Care, Nephrology Division, Kidney Research Institute, Spokane, Washington
- School of Medicine, University of Washington, Seattle, Washington
- Medicine, Washington State University, Seattle, Washington; and
| | | | - Brad P. Dieter
- Providence Health Care, Nephrology Division, Kidney Research Institute, Spokane, Washington
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Neumiller JJ, Rhee CM, Kalantar-Zadeh K. Will Canagliflozin Lend Credence to the Potential Effects of Sodium-Glucose Co-Transporter 2 Inhibitors on Renal Endpoints in Diabetic Nephropathy. Am J Nephrol 2017; 46:459-461. [PMID: 29227973 DOI: 10.1159/000484669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
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Vandermause R, Neumiller JJ, Gates BJ, David P, Altman M, Healey DJ, Benson P, Sunwold D, Burton G, Tuttle KR, Corbett CF. Preserving Self: Medication-Taking Practices and Preferences of Older Adults With Multiple Chronic Medical Conditions. J Nurs Scholarsh 2017; 48:533-542. [PMID: 27802372 DOI: 10.1111/jnu.12250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen. DESIGN A multimethod qualitative design was used. Thirty adults 60 years of age with (a) at least three chronic medical diagnoses, (b) at least five medications at baseline, and (c) a new medication prescription were enrolled in a prospective study of 30 days duration, participating from their homes. METHODS In-depth hermeneutic interviews (2 per 15 participants) and self-assessment diaries recorded on electronic tablets (daily per 30 participants) were completed. Transcribed interviews and self-recorded survey data were analyzed using hermeneutical analysis and ecological momentary assessment and content analysis, respectively. FINDINGS Common reasons participants did not take medications as prescribed included tolerability, transportation, access to medications, and forgetting. The overarching pattern, "preserving self," was supported by two patterns that subsumed several themes: (a) engaging the powerful hold of my illness, and (b) engaging providers in visioning health. CONCLUSIONS A deeper understanding of the impact of receiving a new prescription and of managing medication reveals the challenges patients experience in preserving a sense of self. Healthcare providers of all disciplines should understand the meaning of medication prescribing and medication taking to ameliorate medication-taking difficulties. CLINICAL RELEVANCE The provider-patient relationship is often cited as an area that needs to be addressed in healthcare practice. Our study emphasized the patients' voices and their profound needs around medication management. The emphasis on preservation of self is an important finding that focalizes the concern.
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Affiliation(s)
- Roxanne Vandermause
- Donald L. Ross Endowed Chair for Advancing Nursing Practice, University of Missouri-St. Louis, College of Nursing, St. Louis, MO, USA.
| | - Joshua J Neumiller
- Associate Professor, Washington State University, College of Pharmacy, Spokane, WA, USA
| | - Brian J Gates
- Clinical Professor, Washington State University, College of Pharmacy, Spokane, WA, USA
| | - Prabu David
- Dean, Michigan State University, College of Communication Arts and Sciences, East Lansing, Michigan, USA
| | - Molly Altman
- Research Assistant, Washington State University, College of Nursing, Spokane, WA, USA
| | - Daniel J Healey
- Research Assistant, Washington State University, College of Pharmacy, Spokane, WA, USA
| | | | | | - Gail Burton
- Staff Nurse, Providence Medical Center, Providence Health Care, Spokane, WA, USA
| | - Katherine R Tuttle
- Executive Director for Research, Providence Medical Research Center, Providence Health Care, Spokane, WA, USA.,Clinical Professor of Medicine, University of Washington School of Medicine, Division of Nephrology, Spokane, WA, USA
| | - Cynthia F Corbett
- Professor, Washington State University, College of Nursing, Spokane, WA, USA
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Abstract
Diabetic kidney disease is among the most frequent complications of diabetes, with approximately 50% of patients with ESRD attributed to diabetes in developed countries. Although intensive glycemic management has been shown to delay the onset and progression of increased urinary albumin excretion and reduced GFR in patients with diabetes, conservative dose selection and adjustment of antihyperglycemic medications are necessary to balance glycemic control with safety. A growing body of literature is providing valuable insight into the cardiovascular and renal safety and efficacy of newer antihyperglycemic medications in the dipeptidyl peptidase-4 inhibitor, glucagon-like peptide-1 receptor agonist, and sodium-glucose cotransporter 2 inhibitor classes of medications. Ongoing studies will continue to inform future use of these agents in patients with diabetic kidney disease.
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Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, Washington State University College of Pharmacy, Spokane, Washington;
| | - Radica Z Alicic
- Providence Medical Research Center, Providence Health Care, Spokane, Washington.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington; and
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington; and.,Nephrology Division, Kidney Research Institute and.,Institute of Translational Health Sciences, University of Washington, Seattle, Washington
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50
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Neumiller JJ. 2016 Prescott Lecture: Diabetes education-leadership through action. J Am Pharm Assoc (2003) 2016; 56:611-614. [PMID: 27836122 DOI: 10.1016/j.japh.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
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