Background: To date, there is limited literature regarding the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and pancreatic carcinoma. Objective: To describe the comparative incidence of DPP-4 inhibitors and pancreatic carcinoma as reportedly available in the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. The goal was to provide health care practitioners a general understanding of the drug-disease occurrence. Methods: This is a case/noncase study utilizing Empirica Signal software to query FAERS from November 1968 to December 31, 2013. The software was used to calculate a disproportionality statistic-namely, the empirical Bayesian geometric mean (EBGM)-for reports of DPP-4 inhibitors-associated pancreatic carcinoma. The FDA considers an EBGM significant if the fifth percentile of the distribution is at least 2, defined as an EB 05 ≥ 2. With use of a disproportionality analysis, DPP-4 inhibitors were compared with all agents listed in FAERS. Results: A total of 156 patients experienced pancreatic carcinoma while receiving DPP-4 inhibitor therapy. An EB 05 of 10.3 was determined for sitagliptin, 7.1 for saxagliptin, 4.9 for linagliptin, and 1.4 for alogliptin, compared with all other agents included in FAERS. Although an EB 05 > 2 was achieved in 2 other antihyperglycemic agents, the findings were not consistent within their medication classes. Conclusion: There appears to be a statistical association between DPP-4 inhibitor use and pancreatic carcinoma. Causality cannot be inferred from the data provided. Additional clinical studies are needed to further explore this statistical association.

A review of the identified literature indicated that there is a potential role for the combination of SGLT-2 inhibitors with insulin in T1DM for improving glycemic control without increasing the risk of hypoglycemia. The short duration and small sample sizes limit the ability to fully evaluate the incidences of diabetic ketoacidosis and urogenital infections. The risks associated with this combination of medications require further evaluation.

SGLT-2 inhibitors may be a viable treatment option for patients not controlled on other oral agents. The risk of hypoglycemia is small. However, the clinical efficacy and tolerability of these agents has not been fully elucidated in older and frail patients.

Introduction: Benefits of pharmacist involvement during transitions of care (TOC) are well validated in the literature, but this role remains highly variable and institution specific. The purpose of this study is to describe the impact on acute health care utilization and overall patient outcomes when a pharmacist is added to a unique TOC team that encompasses both ambulatory and acute care settings. Methods: This study is a retrospective review of an established TOC service that recently added a pharmacist. As part of this service, patients meeting prespecified criteria received pharmacist intervention during inpatient rounds and discharge follow-up visit(s). The primary outcome was the change in number of acute health care encounters (emergency department [ED] visits and/or hospital readmissions). Secondary outcomes included type, frequency, and duration of patients' health care encounters, reason(s) for readmissions/ED visits, clinical pharmacist interventions, and changes in disease state-specific outcomes. Patients served as their own control and results were compared between the 6 months prior to and after initial pharmacist intervention. Results: In total, 44 patients were included. In the 6 months following initial pharmacist intervention, total number of acute health care encounters decreased by 39.5% (P < .001). Among patients readmitted or seen in the ED after initial pharmacist intervention, 28.3% occurred within 30 days of hospital discharge. Acute health care utilization was considered preventable in seven (29.2%) hospital readmissions and three (13.6%) ED visits. Average time between admissions increased by 6.6 days (P = .020). Provider-pharmacist discharge co-visits were completed for 75% of patients and a total of 182 pharmacist interventions were performed. Median time to first discharge follow-up visit was six days (interquartile range, 4-8). Conclusion: Incorporating a pharmacist into an established TOC team, working across both the inpatient and outpatient settings, resulted in a significant decrease in number of acute health care encounters per patient and increased time out of the hospital.

Although this work only represents a small sample, results are encouraging. This model can be replicated in other primary care settings with specialty clinicians on site. Specifically, approaches that promote a team-based delivery in a primary care setting may support improved patient outcomes and reduced overall systems' costs. Recommendations for research in a clinical setting are also offered. (PsycINFO Database Record