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Diabetes Update
A Focus on SGLT-2 Inhibitors

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Overview

The number of people affected by diabetes worldwide is growing rapidly. A 2014 national report estimates that 21 million people in the United States have diabetes and another 8.1 million people remain undiagnosed. All together, that is 9.3% of the US population. Around the world, 387 million people have diabetes, - which accounts for 8.3% of the global population. This burden is expected to increase by 205 million people by 2035. Despite advances in technology and drug therapy, many patients do not achieve adequate glycemic control. National guidelines generally recommend hemoglobin A1c (A1C) values less than 6.5-7%. However, the A1C goal should be individualized based on the patient's specific circumstances. The National Committee for Quality Assurance (NCQA) reported that in 2013, only 52-59% of adults with type 1 or type 2 diabetes who had commercial insurance had A1C levels less than 8%. For Medicaid patients, the percentage was even lower at 45.5%.

Expert guidelines generally recommend dual therapy (metformin plus another agent) for patients with A1C values over 7.5%. If the A1C goal has not been achieved after 3 months of dual therapy, progression to triple therapy is recommended. Preferred options (in addition to metformin) for dual therapy include glucagon-like peptide-1 (GLP-1) agonists, sodium glucose transporter-2 (SGLT-2) inhibitors, and dipeptidyl peptidase- 4 (DPP-4) inhibitors. Since about half of the patients with diabetes in the community are not achieving adequate glycemic control, pharmacists have an excellent opportunity to impact and improve their care. They can advocate for medication changes to achieve optimal glycemic control and educate patients about diabetes goals, medication side effects, administration, and potential drug interactions.

SGLT-2 inhibitors are the newest class of diabetes medications, with 3 agents available: canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®). This article will prepare community practitioners to support and educate patients who are already taking these medications, and recommend or initiate their use for patients who are good candidates.

Details

Publication Date: 11/23/2015
Expiration Date: 11/23/2018
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Melody L. Hartzler, PharmD, RPh, AE-C, BCACP is an Assistant Professor of Pharmacy Practice at the Cedarville University School of Pharmacy in Cedarville, OH and a Clinical Pharmacist at the Victor J. Cassano Health Center/ Community Health Centers of Greater Dayton in Dayton, OH. Dr. Hartzler specializes in diabetes and primary care.

Disclosure Statement

Dr. Hartzler is on the Speaker's Bureau for Astra Zeneca Pharmaceuticals, the distributer of dapagliflozin (Farxiga®), an SGLT-2 inhibitor discussed in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Discuss the mechanism of action of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, their potential benefits in addition to glucose lowering, and their advantages/disadvantages compared with other agents.
    2. Name the 3 FDA-approved SGLT-2 inhibitors. Review their indications/role in therapy, contraindications, dosing, recommended monitoring, and drug interactions.
    3. Counsel patients about diabetes treatment goals, follow-up after starting a new medication, and adverse effects of SGLT-2 inhibitors.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-15-011-H01-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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