Objective To review current guidelines and literature regarding continuous glucose monitoring (CGM) use in the management of type 2 diabetes mellitus (T2DM) in older people. Data Sources A PubMed search of articles published through August 2020 using a
combination of the following: older people, T2DM, continuous glucose monitoring, hypoglycemia, and hyperglycemia. Study Selection/Data Extraction Relevant randomized control trials, meta-analyses, and guidelines were assessed for the use of CGM in older patients with T2DM.
Articles were included based on relevance to the topic, detailed methods, and complete results. Data Synthesis CGM use in T2DM management in older people is not well defined. CGM may be a valuable technology in older people who face unique challenges, such as hypoglycemia,
decline in cognitive function, and variable glucose levels. This article provides a review of recommendations for glucose monitoring in T2DM and discusses the role of specific CGM products. Conclusion CGM is a viable option for older people with T2DM to help improve overall
diabetes control. Pharmacists can play an important role in educating patients about this technology.
Background
Pharmacists have demonstrated their value in population health management (PHM). With appropriate training, advanced pharmacy practice experience (APPE) students are also well positioned to participate in PHM.
Methods
At Providence Medical Foundation, a PHM workflow was remodeled to be more standardized and incorporate APPE students into the statin quality measure improvement process. This was driven by institutional goals for quality improvement in patient care and creating a better experiential teaching opportunity. APPE students underwent three training sessions and completed clinical review of patient charts, determined statin eligibility, and completed patient outreach. Rates of statin initiation and student feedback were collected. The rates of statins initiated or declined with this new workflow were retrospectively compared to a previous year's workflow, which was pharmacist‐led.
Intervention
Review pharmacy student involvement with PHM, including statin initiation rates for quality measure improvement as well as student feedback and learning.
Results
Among the 543 patients included in the remodeled workflow, students started statins for 75 (13.8%) patients while 114 (21%) patients declined statins. Among the 829 patients included in the previous year's traditional workflow, pharmacists started statins for 102 (12.3%) patients while 167 (20.1%) patients declined statins. There was no statistically significant difference in rates of statins started (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.63–1.22; p = 0.41) and statins declined (OR 0.95; CI 0.72–1.25; p = 0.73) between the two groups. Student feedback on this activity was positive with self‐reported improvement in confidence, clinical knowledge, and communication skills.
Conclusions
Incorporating pharmacy students into PHM was a valuable learning experience for students and effective for initiating statins to assist with quality measures. Students can be an asset to the team in PHM and help ease resource shortages.
Direct-acting oral anticoagulants (DOACs) are an effective alternative to warfarin for patients with atrial fi brillation (AF) who require thromboembolic risk reduction. This article discusses the newly acceptable use of DOACs in patients with valvular AF, including native valvular heart disease and patients with bioprosthetic valves.
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