Keeping up with new and emerging literature in our field of work can be arduous – especially if governing/regulatory/advisory bodies don’t update their consensus statements or guidelines in a timely fashion.
Hunting through and analyzing clinical trials – while a necessary and important aspect of being a clinical pharmacist – could be a full-time job in and of itself! I think I speak for MANY of us when I say that I am so, so grateful to the ADA for being prompt and thorough in updating their SOMC at least every year. It’s like an extra Christmas present in January that I look forward to and cannot wait to open!
Several key updates came out in 2019 that will influence pharmaceutical care in 2020 – for both children and adults. Here’s my take:
|2020 ADA SOMC1 Update||My Take on Implications for Pharmacy Practice|
|New section added to address “Migrant and Seasonal Agricultural Workers”||Be mindful of Social Determinants of Health (SDoH).2 Refer these patients to social work and community resources. Overarching concerns are lack of regular income and follow-up, language barriers, and unfamiliarity with communities.|
|If indicators of high risk* or established ASCVD, CKD, or HF exist, consider evidence-based SGLT-2i or GLP-1 RA independently of baseline A1c or individualized A1c goal||Regardless of current glycemic control or goals, add the following – in the absence of contraindication, in the order of priority, for the condition that predominates:|
–High risk*/established ASCVD:
1) GLP-1 RA: injectable liraglutide or semaglutide
2) SGLT-2i: empagliflozin, canagliflozin, dapagliflozin
1) SGLT-2i: empagliflozin, canagliflozin, dapagliflozin
2) GLP-1 RA: injectable liraglutide or semaglutide
Choice of agent within class likely 2/2 cost preferred by insurance and should include evaluation of baseline GFR for initiation of
|Oral semaglutide approved by FDA in September 2019||Has not demonstrated same cardioprotective benefit as injectable semaglutide and is not typically preferred by insurances over injectable, cardioprotective GLP-1 RAs. May consider for those patients without ASCVD who would benefit from a GLP-1 RA for weight loss, glycemic control who can afford higher tier medication and/or have needle phobia.|
|Liraglutide approved by FDA in June 2019 for pediatric patients ≥ 10 years||Given the obesity epidemic, need to be more proactive in considering this option for pediatric patients who have not met glycemic targets with metformin and who have none of the contraindications to use for liraglutide.|
|Adoption of continuous glucose monitoring (CGM) metrics into clinical practice||For patients with Type 1 or patients with Type 2 on complicated insulin regimens, use of the actionable, standardized reports with visual cues from CGM can be helpful to interpret data, such as time in range. Trends in reported data may be influential treatment decisions.|
|E-cigarette use should receive cessation counseling in addition to tobacco-containing products||It takes time to review all of the social history, but it is imperative to not only encourage cessation from cigarettes but from vaping products as well. Help patients understand that e-cigarettes are not a healthy bridge to smoking cessation but a health risk in and of themselves.|
*High risk is defined as age ≥ 55 years with coronary, carotid, or lower extremity artery stenosis > 50%, or LVH
αSpecifically, eGFR 30-60 mL/min/1.73m2 or UACR > 3 mg/g, particularly UACR > 30 mg/g
βParticularly HFrEF (LVEF < 45%)
How will these changes influence your practice? What updates do you foresee coming down the road for 2021 and beyond?
Leave your thoughts in the comments below!
- American Diabetes Association. Standards of Medical Care in Diabetes—2020. Diabetes Care 2020 Jan;43(Suppl. 1). Available at https://care.diabetesjournals.org/content/43/Supplement_1
- Social Determinants of Health. Office of Disease Prevention and Health Promotion. Healthy People 2020 website https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Updated January 15, 2020. Accessed January 20, 2020.