Effects of pharmacist intervention on polypharmacy in patients with type 2 diabetes in Japan

2020 ◽  
Author(s):  
Takeshi Horii ◽  
Koichiro Atsuda

Abstract Objective Investigation of polypharmacy in patients with type 2 diabetes revealed that the medications being administered according to the patient’s symptoms and complaints strongly contributed to polypharmacy. We explored the effects of clinical ward pharmacy service, which evaluated the need for symptomatic treatment, therefore minimizing polypharmacy by reducing inappropriate medications. Results The number of drugs [hospitalization vs. discharge: 9 (1-17) vs. 7 (1-16), P < 0.001] and rate of PP (hospitalization vs. discharge: 75.4% vs. 61.1%, P < 0.001) were significantly lower at discharge. Since hospital admission, the number of drugs increased (n = 6, 11%), remained unchanged (n = 15,28%), decreased by 1 drug (n = 4,8%), decreased by 2 drugs (n = 3,6%), and decreased by more than 2 drugs (n = 25,5%). Daily drug costs were significantly reduced (hospitalization vs. discharge: $8.3 vs. $6.1, P < 0.001).

Author(s):  
Rick I. Meijer ◽  
Trynke Hoekstra ◽  
Niels C. Gritters van den Oever ◽  
Suat Simsek ◽  
Joop P. van den Bergh ◽  
...  

Abstract Purpose Inhibition of dipeptidyl peptidase (DPP-)4 could reduce coronavirus disease 2019 (COVID-19) severity by reducing inflammation and enhancing tissue repair beyond glucose lowering. We aimed to assess this in a prospective cohort study. Methods We studied in 565 patients with type 2 diabetes in the CovidPredict Clinical Course Cohort whether use of a DPP-4 inhibitor prior to hospital admission due to COVID-19 was associated with improved clinical outcomes. Using crude analyses and propensity score matching (on age, sex and BMI), 28 patients using a DPP-4 inhibitor were identified and compared to non-users. Results No differences were found in the primary outcome mortality (matched-analysis = odds-ratio: 0,94 [95% confidence interval: 0,69 – 1,28], p-value: 0,689) or any of the secondary outcomes (ICU admission, invasive ventilation, thrombotic events or infectious complications). Additional analyses comparing users of DPP-4 inhibitors with subgroups of non-users (subgroup 1: users of metformin and sulphonylurea; subgroup 2: users of any insulin combination), allowing to correct for diabetes severity, did not yield different results. Conclusions We conclude that outpatient use of a DPP-4 inhibitor does not affect the clinical outcomes of patients with type 2 diabetes who are hospitalized because of COVID-19 infection.


2016 ◽  
Vol 64 (6) ◽  
pp. 1358-1364 ◽  
Author(s):  
Sarah H. Wild ◽  
Joanne R. Morling ◽  
David A. McAllister ◽  
Jan Kerssens ◽  
Colin Fischbacher ◽  
...  

2021 ◽  
Vol 5 (3) ◽  
pp. 01-04
Author(s):  
Nasser Mikhail

Background: The effects of metformin therapy on the prognosis of patients with coronavirus disease 2019 (COVID-19) are unclear. Objective: To review effects of metformin on clinical outcomes, particularly mortality, in patients with type 2 diabetes and COVID-19. Methods: Review of English literature by PUBMED search until April 20, 2021. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, and consensus guidelines are reviewed. Results: All available studies in this area are retrospective. Two population-based studies did not find significant association between metformin use and susceptibility to COVID-19. Most, but not all studies, suggest that metformin use prior to hospital admission might be associated with significant decrease in mortality in patients with type 2 diabetes and COVID-19. Continuing metformin use after hospital admission did not have significant impact on COVID-19 related death but may decrease risk of acute respiratory distress syndrome (ARDS). Meanwhile, in-hospital metformin administration may be associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking ≥2 gm/d of metformin, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Conclusions: Although most retrospective studies suggest that metformin administration may be associated with decreased risk of COVID-19 mortality, these data should be confirmed by randomized trials. In patients with type 2 diabetes and COVID-19 admitted to the hospital, metformin use should be avoided in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73m2), and in daily doses of ≥ 2 gm due to increased risk of lactic acidosis.


2018 ◽  
Vol 48 (10) ◽  
pp. 1198-1205
Author(s):  
Rachel T. McGrath ◽  
Justin C. Dryden ◽  
Neroli Newlyn ◽  
Elline Pamplona ◽  
Judy O'Dea ◽  
...  

2019 ◽  
Vol 59 ◽  
pp. 53-59 ◽  
Author(s):  
Nuria Muñoz-Rivas ◽  
Rodrigo Jiménez-García ◽  
Manuel Méndez-Bailón ◽  
Valentín Hernández-Barrera ◽  
Javier de Miguel-Díez ◽  
...  

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