The effectiveness of dapagliflozin in the management of type-2 diabetes mellitus (T2-DM) is an essential issue for establishing a basis for prescribing dapagliflozin. This study aimed to assess the effectiveness of dapagliflozin in combination with other hypoglycemic agents (OHAs) in reducing glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) at 3, 6, 9 and 12 months. This retrospective observational study included all patients who visited the endocrine clinics at Hamad Medical Corporation (HMC) and were treated with dapagliflozin. Demographics and laboratory data were obtained retrospectively from computerized patient medical profiles (eMR-viewer). The main outcome measures were the differences in HbA1c and FBG from baseline at different months. Eighty-one Qatari patients were found to have received dapagliflozin during the study period; 72% of them (n = 58) were males, with a mean age of 57.0 ± 9.0 years and a mean baseline HbA1c of 9.0 ± 1.4%. Administration of dapagliflozin as an add-on therapy was found to decrease HbA1c significantly by 0.8 percentage point after 6 months (P = 0.006) and by 1.5 percentage point after 12 months (P = 0.062). FBG was significantly reduced at 6 months and 9 months (P = 0.001 and P = 0.03, respectively). Dapagliflozin effectively reduced the HbA1c level and FBG when used in combination with other OHAs or insulin within 6 to 12 months.
Background Metabolic syndrome is a cluster of factors that increase the risk of cardiovascular disease and include: diabetes and prediabetes, abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol and high bloodpressure. However, the role of the pharmacist in the metabolic syndrome has not yet been fully explored. Aim of the review This systematic review aimed to critically appraise, synthesise, and present the available evidence on pharmacists' input to the screening, prevention and management of metabolic syndrome. Method The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)". Studies published in English from January 2008 to March 2020 reporting any pharmacist activities in the screening, prevention or management of metabolic syndrome were included. Databases searched were Medline, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Cochrane and Google Scholar. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results Of the 39,430 titles reviewed, ten studies were included (four were randomised controlled trials). Most studies focused on pharmacist input to metabolic syndrome screening and management. Screening largely involved communicating metabolic parameters to physicians. Management of metabolic syndrome described pharmacists collaborating with members of the multidisciplinary team. A positive impact was reported in all studies, including achieving metabolic syndrome parameter goals, reverting to a non-metabolic syndrome status and, improved medication adherence. The populations studied were paediatrics with risk factors, adults with comorbidities and psychiatric patients. Integration of the pharmacist within the multidisciplinary team, an easy referral process and accessibility of service were potential facilitators. Inadequate funding was the key barrier. Conclusion The studies describing pharmacist input in metabolic syndrome provide limited evidence of positive outcomes from screening and management as part of collaborative practice. Further work is required to provide more robust evidence of effectiveness and cost-effectiveness while considering key barriers.
Background: Co-trimoxazole is a broad-spectrum antibiotic associated with hyperkalemia. Objective: To determine the incidence of hyperkalemia and its risk factors in patients receiving co-trimoxazole. Materials and Methods: A retrospective observational study involving all patients who received co-trimoxazole between 1 January 2012 and 1 January 2013 was conducted. Subjects were identified through a list generated from a computerized pharmacy system. The patients' demographic and clinical characteristics were retrieved from electronic medical records. Data were analyzed using univariate and multivariate logistic regression. Results: One hundred sixty-one patients fulfilled the eligibility criteria. Of these, 46 (28.6%) experienced hyperkalemia. Around 35 (76%) of the patients who experienced hyperkalemia received co-administered medications that might induce hyperkalemia. The coadministration of co-trimoxazole with other medications that may induce hyperkalemia was found to be associated with higher incidence of hyperkalemia when compared to cotrimoxazole administration alone [adjusted OR 3.2, 95% CI (1.4-7.3), p=0.005]. Additionally, age > 60 years was associated with an increased risk of hyperkalemia when compared to younger age group 18-39 years [adjusted OR 6.5, 95% CI (2.1-19.7); p=0.001]. Conclusion: Co-trimoxazole use is associated with high incidence of hyperkalemia, especially among older patients and those receiving it in combination with other medications that might contribute to hyperkalemia development such as calcineurin inhibitors and β-blockers.
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