Consequences of non-medical switch among patients with type 2 diabetes

OBJECTIVE

This study aimed to describe real-world experiences following a non-medical switch among adults with type 2 diabetes mellitus (T2DM) in the United States.

METHODS

For this cross-sectional study, patients with T2DM (N = 451) provided data on demographics, and how a non-medical switch of their anti-hyperglycemic agent (AHA) affected their general health, HbA1c levels and medication management, via an Internet-based survey. Patients self-reported their level of satisfaction with the original medication and emotional reactions to the non-medical switch. Patients who recently experienced a non-medical switch of their AHA(s) (n = 379) were asked about the consequences of switching and their satisfaction with the switch (vs. the original) medication.

RESULTS

Patients most frequently reported feeling very/extremely frustrated, surprised, upset and angry in reaction to a non-medical switch. Patients were somewhat satisfied with their original medication. Between 20% and 30% of patients reported the non-medical switch had a moderate/major effect on their general health, diabetes, mental well-being and control over their health. The blood glucose levels of recent switchers were somewhat/much worse (20.7%) and medication management was somewhat/much worse (12.9%) on the switch (vs. the original) medication. Some recent switchers reported old symptoms returning (7.7%) and experiencing new side-effects (14.2%).

CONCLUSIONS

Approximately one in five patients reported a moderate/major negative impact on their blood glucose level, diabetes, mental well-being, general health and control over their health following a non-medical switch. Findings suggest that a non-medical switch may have unintended negative health consequences and results in considerable burden across multiple domains for a sizeable minority of patients with T2DM.

Medication-related problems in CKD

Patients with CKD are often prescribed heterogeneous medications to treat disease-associated comorbidities, to slow down progression of the disease, and to minimize morbidity and mortality rates. However, the medication regimens of this population are very complex, leading to an increased potential for medication-related problems (MRPs). As kidney function declines, the type and amount of medications a patient consumes increases, thereby putting them at a higher risk for MRPs. MRPs have been known to be associated with morbidity, mortality, and a lower quality of life. This review will summarize data on the prevalence and effect of MRPs, and strategies that can be used by clinicians to reduce and resolve MRPs.

Meeting New Challenges in the Management of Anemia of Chronic Kidney Disease Through Collaborative Care with Pharmacists

Objective:

To evaluate chronic kidney disease (CKD)–associated anemia management challenges and limitations and discuss strategies to improve treatment rates and patient response to therapy, monitoring of patient response to therapy, and education of prescribing providers and patients.

Data Sources:

Multiple MEDLINE searches were performed using a comprehensive search term list to identify studies for inclusion, including, but not limited to, anemia, erythropoiesis-stimulating agent (ESA), epoetin, darbepoetin, CERA, hemoglobin, CKD, dialysis, end-stage renal disease, quality of life, and pharmacist. Annual data reports and clinical practice guidelines published by the National Kidney Foundation and US Renal Data System were included. Information provided within product package inserts for recombinant human erythropoietin (epoetin alfa; Epogen, Procrit) and darbepoetin alfa (Aranesp) were also included.

Study Selection and Data Extraction:

Only articles that were published in English and were relevant for this review were included.

Data Synthesis:

Anemia is a common complication of CKD, with significant impact on patients' quality of life. Anemia of CKD represents a significant burden on the healthcare system, with ESA use resulting in substantial financial costs. As new therapies, formularies, and dosing regimens evolve, the collaborative role of the clinical pharmacist is integral to a multidisciplinary treatment strategy, both in the inpatient and outpatient settings, such as hospitals or dialysis centers, respectively. This review focuses on initial and target hemoglobin (Hb) concentrations, as well as patient characteristics, treatment preferences, and dosing schedules, which are important considerations in managing CKD-associated anemia. To ensure effective therapeutic strategies, a patient-centered approach is required. Pharmacists are ideally positioned to help select ESA therapy, influence formulary use, educate healthcare professionals and patients, develop and implement dosing and monitoring protocols, and possibly promote quality improvement.

Conclusions:

An approach to CKD-associated anemia management that involves collaboration with pharmacists is essential to achieve patient-specific, cost-effective ESA therapy.

Genetic diversity and differentiation of Taxodium in the south-eastern United States using cleaved amplified polymorphic sequences

Two taxa of Taxodium, bald cypress and pond cypress, occur in the south-eastern United States. The ranges of these taxa overlap in the south-eastern Coastal Plain, with the range of the latter being more restricted. Although these taxa co-occur throughout a portion of the more expansive range of bald cypress (Taxodium distichum (L.) L. C. Rich), the habitats of the two taxa appear to differ. Consequently, considerable debate has occurred regarding the taxonomic status of pond cypress. Some authors recognize pond cypress as a distinct species (Taxodium ascendens Brongn.), whereas others recognize it as a variety/ecotype (Taxodium distichum var. imbricarium (Nutt.) Croom). In this study, the genetic diversity of these two taxa was investigated using 10 DNA markers based on sequences from cDNA clones of Cryptomeria japonica. Cryptomeria is a monospecific genus native to Japan, and is a close relative of Taxodium. These markers were codominant in Cryptomeria and were presumed to be codominant in Taxodium. DNA was extracted from leaf tissue collected from six populations of bald cypress and seven populations of pond cypress throughout Florida and Georgia. The average heterozygosities of bald cypress and pond cypress were 0.386 (SE 0.040) and 0.380 (SE 0.040), respectively. Most of the genetic variation (91.9%) was found within populations, 4.9% was found between populations and 3.2% between taxa. Results of DNA analysis using cleaved amplified polymorphic sequences (CAPS) in this study did not suggest that pond cypress was a species distinct from bald cypress. Our conclusion is that the two taxa of Taxodium should be given varietal status.

Histological changes associated with enlargement and regression of the thymus glands of the red-billed quelea Quelea quelea L. (Ploceidae: weaver-birds)

Thymic lobes form over 200 red-billed queleas, Quelea quelea L., were examined histologically. Samples were taken from embryos about to hatch, juveniles and adults. The lobes varied in size from very small to very enlarged (1- greater than 5 mm long). The constituent cell types are described in detail and the occurrence of these cells in different sized lobes is discussed. A cycle of events is proposed which accounts for the observations presented here. It is suggested that the large numbers of erythroid cells found in the cortex of some individuals were developing in situ. The significance of erythropoiesis within the thymus is discussed.