Type 2 diabetes disproportionately affects Latinos increasing their risk of diabetes-related complications. This study used a randomized controlled design with a community-based approach to evaluate the impact of a culturally tailored pharmacist intervention on clinical outcomes in Latino diabetics. The intervention included a focused discussion and two individual pharmacist counseling sessions on medication, nutrition, exercise, and self-care to promote behavior changes. Sessions were culturally adapted for language, diet, family participation, and cultural beliefs. Clinical outcomes were measured at baseline and three months. Nineteen intervention and 24 control participants completed the study. Mean BMI reduction was greater for intervention than for control group participants (-0.73 ± 0.07 kg/m2 versus + 0.37 ± 0.02 kg/m2 p<.009 respectively). Hemoglobin A1c was significantly reduced by 0.93 ± 0.45% in the intervention group only. There was no significant difference in blood glucose, blood pressure, or lipid levels. An innovative culturally-sensitive pharmacist intervention improved selected clinical outcomes among Latino diabetics.
Linagliptin was associated with modest but significant reduction in HbA1c and FPG and improved DI after 12-24 weeks. Patients who would probably benefit most are those with HbA1c <9%, already on an active agent, compliant with weight reduction strategies, and can recognize and manage hypoglycaemia, fluid retention and upper respiratory tract infections. Long-term studies are needed to determine durability of response, incidence of microvascular and macrovacular complications, cost-effectiveness and safety.
Background: Levocetirizine (LCZ), the active R-enantiomer of cetirizine, is a second-generation antihistamine approved for symptom treatment due to seasonal allergic rhinitis (SAR), perennial allergic rhinitis, and chronic idiopathic urticaria in patients $6 months of age. Objective: To review available literature about pharmacokinetics, pharmacodynamics, efficacy, tolerability, quality of life, and pharmacoeconomics of LCZ use in adults and children with SAR. Methods: Databases searched were: MEDLINE, CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, EMBASE, NHS Economic Evaluation Database, and Database of Abstracts of Reviews of Effectiveness. Search terms included levocetirizine, histamine H 1 antagonists-non-sedating, seasonal allergic rhinitis, pregnancy, quality of life, case reports, cost, and pharmacoeconomics. Relevant article reference lists were also used to obtain additional articles. Results: LCZ exhibits rapid and extensive absorption, high affinity/selectivity for H 1 receptor, and rapid onset and long duration of action. Eight articles assessing clinical efficacy were reviewed. In 4 placebo-controlled studies, LCZ 5 mg/day significantly reduced nasal symptoms in 3 studies and had similar efficacy in 1 study. LCZ was more effective in reducing SAR symptoms vs. desloratadine 5 mg/day but not vs. rupatadine (RUP) 10 mg/day, and RUP was more effective than LCZ in reducing nasal symptoms (P = 0.02). Addition of LCZ 5 mg/day to fluticasone nasal spray therapy improved nasal blockage symptoms only (P , 0.005). Studies investigating anti-inflammatory effects produced inconsistent results. LCZ was not associated with serious adverse events and is generally well tolerated with complaints of somnolence and fatigue; also, there was an increase in febrile seizures in infants. Conclusion: LCZ is an effective and well-tolerated second-generation antihistamine used for the treatment of SAR in adults and children, but its effects on inflammatory markers and performance versus other treatment options require further investigation.
on use of linagliptin in combination with the three studied agents (metformin, sulfonylurea or pioglitazone) and patient counselling included weight reduction strategies and recognition/management of hypoglycaemia, fluid retention and upper respiratory tract infections. We agree that in the individual studies of patients receiving linagliptin monotherapy, as add-on to metformin, or as add-on to metformin and sulphonylurea, weight changes were similar to placebo in that patients could either gain or lose weight; however, when linagliptin is added to pioglitazone therapy, patients were more likely to gain weight [1]. A small average weight gain (0.36 kg) was found in our meta-analysis of these studies (figure 6). If we remove the pioglitazone-linagliptin study from the meta-analysis, the results still show a small, statistically significant, weight gain with linagliptin (0.27 kg, 0.05-0.51, p = 0.02, I 2 = 0%).We agree with the authors that linagliptin is not associated with fluid retention and extraordinary vigilance is not needed. It is a concern only if patients are also receiving pioglitazone, as fluid retention is an adverse event associated with thiazolidinediones [2]. In regards to hypoglycaemia, if a patient will receive linagliptin in combination with metformin and sulphonylurea, there is a potential for hypoglycaemia Study or Subgroup Linagliptin vs PlaceboDel Prato NCT00798161 Subtotal (95% CI) Heterogeneity: Tau² = 4.02; Chi² = 3.76, df = 1 (P = 0.05); I² = 73% Test for overall effect: Z = 1.20 (P = 0.23) Linagliptin+Metformin vs Metformin NCT00798161 Taskinen Subtotal (95% CI)Heterogeneity: Tau² = 1.98; Chi² = 2.85, df = 1 (P = 0.09); I² = 65% Test for overall effect: Z = 2.15 (P = 0.03) Total (95% CI)Heterogeneity: Tau² = 1.14; Chi² = 6.64, df = 3 (P = 0.08); I² = 55% Test for overall effect: Z = 3.39 (P = 0.0007)
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