Debbie Rigby takes a look at the latest research relevant to pharmacists from around the world
Using a large U.K. primary care database, researchers have analysed the risks and benefits of newer diabetes drugs, including glitazones and gliptins. The risk of hyperglycaemia among patients prescribed dual therapy involving metformin with either gliptins or glitazones was less compared with metformin alone. Compared with metformin monotherapy, triple therapy with metformin, sulphonylureas, and either gliptins or glitazones was associated with an increased risk of hypoglycaemia, which was similar to the risk for dual therapy with metformin and sulphonylureas. Compared with metformin monotherapy, triple therapy with metformin, sulphonylureas, and glitazones was associated with a reduced risk of blindness.
High-quality evidence about glycemic treatment in older adults is lacking. Optimal decisions need to be made collaboratively with patients, incorporating the likelihood of benefits and harms and patient preferences about treatment and treatment burden. Intensive glycemic control immediately increases the risk of severe hypoglycemia 1.5- to 3-fold. For the majority of older adults, an HbA1c target between 7.5% and 9% will maximize benefits and minimize harms.
Estimates of nonadherence in the type 2 diabetes population range from 50%11 to as high as 93%. Improved adherence to therapy requires establishing patient ownership through behaviours that denote cognitive participation, shared knowledge and meaning, and the belief in the value of the intervention within the patient’s lifestyle and personal preference. Focusing on the patient-centered nature of the intervention in addressing behavioural, emotional, situational, and cognitive barriers may be a more effective way of making treatment and behaviour adherence recommendations.
Journal of Multidisciplinary Healthcare 2016:9 133-6.
Fourteen papers and 1 congress abstract with 23,168 COPD patients were included in this systematic review and meta-analysis of LAMA/LABA fixed dose combination products. The review showed that all LAMA/LABA combinations were always more effective than the LAMA or LABA alone in terms of the improvement in trough FEV1. There was no significant difference among LAMA/LABA combinations.
Chest. 2016. doi:10.1016/j.chest.2016.02.646