Pharmacy and Pharmaceutical Sciences Commons^™

Geospatial Distribution Of Pharmacist Diabetes Management Within A Patient Centered Medical Home Model In Omaha, Nebraska, Anthony Donovan

Capstone Experience

Patients with uncontrolled diabetes, defined as a hemoglobin A1c value greater than 9%, are at an increased risk of diabetes progression. Primary care is often the first point of contact where patients with uncontrolled diabetes are identified and treated. Pharmacists are utilized in diabetes medication management of patients with uncontrolled diabetes as one component of primary care multidisciplinary models of care. This descriptive project describes the geospatial distribution of patients with uncontrolled diabetes from a single institution in the Omaha, Nebraska area who were exposed to pharmacists within a Patient Centered Medical Home (PCMH) model of care compared to those …

Cgm Use With Interprofessional Therapy Management Improves Hba1c Levels In T2dm Patients, Stephen R. Hill, Courtney Robertson, Teri B. O'Neal, Sonia Garner

Journal of Interprofessional Practice and Collaboration

Background

Type 2 Diabetes Mellitus (T2DM) is a chronic disease state with increased complications over time from uncontrolled glucose. Significant data has shown benefits of continuous glucose monitoring (CGM) in reducing glycated hemoglobin (HbA1c) levels of Type 1 Diabetes Mellitus (T1DM) patients, but a lack of robust evidence is seen in T2DM. This study assessed the impact of short-term CGM placement on HbA1c levels in T2DM.

Objectives

The primary outcome was the change in baseline HbA1c levels in patients with T2DM up to six months after CGM placement. Secondary outcomes assessed intensification of diabetes medications made by an interprofessional team …

Diabetes-Associated Hyperglycemia Causes Rapid-Onset Ocular Surface Damage, Judy Weng, Christopher Ross, Jacob Baker, Saleh Alfuraih, Kiumars Shamloo, Ajay Sharma

Pharmacy Faculty Articles and Research

Purpose: The metabolic alterations due to chronic hyperglycemia are well-known to cause diabetes-associated complications. Short-term hyperglycemia has also been shown to cause many acute changes, including hemodynamic alterations and osmotic, oxidative, and inflammatory stress. The present study was designed to investigate whether diabetes-associated hyperglycemia can cause rapid-onset detrimental effects on the tear film, goblet cells, and glycocalyx and can lead to activation of an inflammatory cascade or cellular stress response in the cornea.

Methods: Mouse models of type 1 and type 2 diabetes were used. Tear film volume, goblet cell number, and corneal glycocalyx area were measured on …

Pre-Existing Diabetes Mellitus, Hypertension And Kidneydisease As Risk Factors Of Pre-Eclampsia: A Disease Of Theories And Its Association With Genetic Polymorphism, Abdullah Salah Alanazi, Francis Victor, Kanwal Rehman, Yusra Habib Khan, Ismaeel Yunusa Ph.D., Abdulaziz Alzarea, Muhammad Sajid Hamid Akash, Tauqeer Hussain Mallhi

Faculty Publications

Pre-existing diabetes, hypertension and kidney disorders are prominent risk factors of pre-eclampsia (PE). It is a multifactorial pregnancy disorder associated with high blood pressure, proteinuria, and multiorgan failure, which develops after the 20th week of pregnancy. It is one of the most feared pregnancy disorders, as it consumes thousands of fetomaternal lives per annum. According to clinical and pathological studies, the placenta appears to be a key player in the pathogenesis of PE; however, the exact origin of this disorder is still under debate. Defective placentation and angiogenesis are the hallmarks of PE progression. This angiogenic imbalance, together with maternal …

Effects Of Glp-1 Receptor Agonists On Cardiovascular Outcomes In Patients With Type 2 Diabetes And Chronic Kidney Disease: A Systematic Review And Meta-Analysis, Michael Kelly, Jelena Lewis, Hindu Rao, Jessica Carter, Ivan Portillo, Richard Beuttler

College of Pharmacy Faculty Papers

AIM: To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157). …

The Glycemic, Cholesterol, And Weight Effects Of L-Carnitine In Diabetes: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials, Jennifer Ko, Eva Y. Wong, Huyentran N. Tran, Rebecca J.C. Tran, Diana X. Cao

Pharmacy Faculty Articles and Research

Introduction

L-carnitine possibly impacts insulin sensitivity and glucose metabolism. However, its therapeutic role in diabetes is poorly understood.

Methods

A systematic review and meta-analysis were conducted using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception through June 30, 2021. Included studies evaluated the use of L-carnitine in diabetes on fasting blood glucose (FBG), hemoglobin A1c (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), weight, or body mass index (BMI). Weighted mean difference (WMD) and 95% confidence intervals (CI) were calculated using the DerSimonian and Laird random-effects model.

Results

Seventeen studies …

Effects Of Glp-1 Receptor Agonists On Cardiovascular Outcomes In Patients With Type 2 Diabetes And Chronic Kidney Disease: A Systematic Review And Meta-Analysis, Michael S. Kelly, Jelena Lewis, Hindu Rao, Jessica Carter, Ivan Portillo, Richard Beuttler

Pharmacy Faculty Articles and Research

Aim

To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

Materials and Methods

We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157). …

Medication Therapy Management Implementation In Conjunction With A Rural Health Clinic In Minnesota: A Cqi Impact On Diabetes Metrics, Abigail Sirek Pharmd

Theses and Dissertations

The purpose of this continuous quality improvement project was to implement a pharmacist-led Medication Therapy Management (MTM) clinic in rural, central Minnesota and assess the impact on patients’ healthcare over a six-month period. Patients were identified through the clinic’s diabetes registry, which included patients 18 through 75 years old with a diagnosis of diabetes not meeting all five D5 goals, as recommended by the Minnesota Community Measurements, independently referred by the provider, or be identified by their insurance company as a patient that would benefit from an MTM visit. The D5 focuses on blood pressure and blood sugar control, appropriate …

Rap1a Activity Elevated The Impact Of Endogenous Ages In Diabetic Collagen To Stimulate Increased Myofibroblast Transition And Oxidative Stress, Stephanie D. Burr, Christopher C. Dorroh, James A. Stewart

Faculty and Student Publications

Diabetics have an increased risk for heart failure due to cardiac fibroblast functional changes occurring as a result of AGE/RAGE signaling. Advanced glycation end products (AGEs) levels are higher in diabetics and stimulate elevated RAGE (receptor for AGE) signaling. AGE/RAGE signaling can alter the expression of proteins linked to extracellular matrix (ECM) remodeling and oxidative stressors. Our lab has identified a small GTPase, Rap1a, that may overlap the AGE/RAGE signaling pathway. We sought to determine the role Rap1a plays in mediating AGE/RAGE changes and to assess the impact of isolated collagen on further altering these changes. Primary cardiac fibroblasts from …

Assessing Nutritional Health Knowledge In Sharing Clinic Patients With Diabetes, Minden Huntrods

Capstone Experience

Effective diabetes prevention and management relies on nutritional behaviors, thus a basic level of health knowledge is important for patients with diabetes and their caregivers in their quest to acquire acute glycemic control and minimize negative health outcomes (Ley et al., 2014). The purpose of this study was to assess the nutrition-related health knowledge of patients living with diabetes who are seen at the UNMC Sharing Clinic by use of a verbal questionnaire. This nutritional health knowledge assessment was a quantitative, prospective, survey-based study utilizing descriptive statistics. Approximately 86% of patients were proficient in food group and nutritious foods knowledge …

Trends In Insulin Prescribing For Patients With Diabetes During The Covid-19 Pandemic In The Us, Ismaeel Yunusa Ph.D., Bryan L. Love Pharm D., Chao Cai, Tessa Hastings, Claiborne E. Reeder, Elizabeh W. Blake, Cynthia Phillips

Faculty Publications

Introduction

For the approximately 7 million US individuals with diabetes who rely on insulin,¹ the number of insulin prescriptions rose steadily in the decade before the COVID-19 pandemic.² Reduced access to medical care and disruptions in supply related to the pandemic may have decreased access to insulin,³ with possible adverse consequences for diabetes control.⁴ Conversely, emergency Medicaid expansions that increased capacity for telemedicine services during the pandemic may have been associated with improved access to treatment.⁵ Therefore, this study aimed to assess whether changes to insulin prescription claims occurred during the COVID-19 pandemic.

Methods

In …

Evaluating A1c Reduction In Patients With Diabetes Receiving Pharmacy Intervention, Christopher R. Evans, Kirsten Held, Stephanie Thomas, Jeanne Spencer

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Diabetes affects 34 million Americans and is the 7th leading cause of death in the United States. According to the American Diabetes Association (ADA) the A1c goal for most patients is less than 7%; however, in patients at risk for hypoglycemia or with complications that goal can be increased up to less than 8%. Management of diabetes with diet and exercise is essential, but insufficient for most patients and pharmacologic intervention is necessary to achieve therapeutic goals. Reducing A1c is associated with lower cardiovascular risk and a reduction in diabetes-associated complications. Previous studies have shown that pharmacist management of …

Rap1a Regulates Cardiac Fibroblast Contraction Of 3d Diabetic Collagen Matrices By Increased Activation Of The Age/Rage Cascade, Stephanie D. Burr, James A. Stewart

Faculty and Student Publications

Cardiovascular disease is a common diabetic complication that can arise when cardiac fibroblasts transition into myofibroblasts. Myofibroblast transition can be induced by advanced glycated end products (AGEs) present in the extracellular matrix (ECM) activating RAGE (receptor for advanced glycated end products) to elicit intracellular signaling. The levels of AGEs are higher under diabetic conditions due to the hyperglycemic conditions present in diabetics. AGE/RAGE signaling has been shown to alter protein expression and ROS production in cardiac fibroblasts, resulting in changes in cellular function, such as migration and contraction. Recently, a small GTPase, Rap1a, has been identified to overlap the AGE/RAGE …

Development And Evaluation Of A Diabetes Themed Escape Room For Students Completing An Ambulatory Care Advanced Pharmacy Practice Experience, Katherine Frances Brown

Undergraduate Honors Thesis Collection

Introduction: Escape rooms are a novel form of entertainment that have become increasingly popular in the United States. The idea of an escape room has great potential for educational purposes as well. In professional healthcare schooling, they have been used to supplement what students learn in the classroom. Interactive learning through the use of an escape room has been studied in the setting of pharmacy students completing their third year of traditional didactic learning. As of yet, there is no published literature that analyzes the use of escape rooms in the Advanced Pharmacy Practice Experience (APPE) setting.

Objectives: The primary …

Rap1a Overlaps The Age/Rage Signaling Cascade To Alter Expression Of Α‐Sma, P‐Nf‐Κb, And P‐Pkc‐Ζ In Cardiac Fibroblasts Isolated From Type 2 Diabetic Mice, Stephanie D. Burr, James A. Stewart

Faculty and Student Publications

Cardiovascular disease, specifically heart failure, is a common complication for individu-als with type 2 diabetes mellitus. Heart failure can arise with stiffening of the left ventricle, which can be caused by “active” cardiac fibroblasts (i.e., myofibroblasts) remodeling the extracellular matrix (ECM). Differentiation of fibroblasts to myofibroblasts has been demonstrated to be an outcome of AGE/RAGE signaling. Hyperglycemia causes advanced glycated end products (AGEs) to accu-mulate within the body, and this process is greatly accelerated under chronic diabetic conditions. AGEs can bind and activate their receptor (RAGE) to trigger multiple downstream outcomes, such as altering ECM remodeling, inflammation, and oxidative stress. …

Drug Delivery Systems: Exploring Rheological Properties And Therapeutic Effect Of 5-Fu Chitosan Gel For Topical Wound Healing, Samuel Tetteh-Quarshie

Theses, Dissertations and Capstones

Diabetic skin wound is a common complication of diabetes that occurs in about 15% of diabetic patients and often requires prolonged hospitalization for its management and treatment. Natural polymers are used for wound dressing due to their biological adhesiveness, non-toxicity, and biodegradable nature. 5-Fluorouracil (FU) has been shown to alter adipokine expression which is implicated in cutaneous wound repair. Thus, our overall objective was to investigate the utility of chitosan (CS) gel for topical delivery of 5-FU to treat diabetic wounds. We prepared chitosan gel (2% w/w) in serial dilutions of 5-FU (25μg/mL, 2.5μg/mL, 0.25μg/mL, and 0.025μg/mL) and evaluated their …

Analysis Of Hba1c, Medication Compliance, Income Subsidies, And Comorbidity In Medicare Type 2 Diabetics, Robert E. Lazarchik

Walden Dissertations and Doctoral Studies

Diabetes is one of America’s leading chronic diseases with comorbidities contributing to lower health statuses and increased health care costs. While it is known that lowering HbA1c reduces the deleterious effects of diabetes, the capability to identify people with diabetes at risk for uncontrolled HbA1c levels or developing comorbidities based on the compliance rates for different oral antihyperglycemic medication classes (OAMCs) and financial assistance programs does not yet exist. These quantitative longitudinal retrospective studies examined the association between medication compliance, using Proportion of Days Covered (PDC), by OAMC and Medicare financial aid programs, on predicting HbA1c levels and comorbidities in …

Assessing Consistency With Standards Of Care Recommendations For Patients With Type 2 Diabetes At Hospital Discharge, Katherine Brown Pharmd, Timothy L. Johnston Bpharm, Pharmd, Bcps, Bcccp, Andrea Sloat Pharmd

Parkview Pharmacy Department

2021 ASHP Midyear Clinical Meeting / Poster ID#1129514

Objective: To assess the number of patients prescribed diabetic regimens consistent with American Diabetes Association (ADA) Standards of Care recommendations upon hospital discharge.

Health Insurance Plan Design And Chronic Disease Management, Daniel E. Feldman

Electronic Theses and Dissertations

Each year, Americans spend more money on health care than any other industrialized nation, despite comparable mortality rates for people with risk factors for heart disease. The reasons for this lack of health care value in the US are numerous and complex – including market distortions like supplier-inflated pricing and regulatory structures that enable consumers to utilize ubiquitous, high-cost medical technologies that yield uncertain benefits. Health insurance, once thought to be an insignificant contributor to rising health spending, has changed considerably in the past few decades in ways that make it more accessible and more generous in coverage. Health insurance …

Extracellular Matrix Components Isolated From Diabetic Mice Alter Cardiac Fibroblast Function Through The Age/Rage Signaling Cascade, Stephanie D. Burr, James A. Stewart

Faculty and Student Publications

© 2020 The Authors Individuals suffering from diabetes have an increased risk of developing cardiovascular complications such as heart failure. Heart failure can be a result of the stiffening of the left ventricle, which occurs when cardiac fibroblasts become “active” and begin to remodel the extracellular matrix (ECM). Fibroblast “activation” can be triggered by the AGE/RAGE signaling cascade. Advanced Glycation End products (AGEs) are produced and accumulate in the ECM over time in a healthy individual, but under hyperglycemic conditions, this process is accelerated. In this study, we investigated how the presence of AGEs in either non-diabetic or diabetic ECM …

Improving Diabetes Self-Management Developing A Patient Decision Aid To Improve Patient Education, Morgan Baker

Honors Theses

Type 2 diabetes is a complex disease that affects a large population of people. It is imperative that efforts are made to develop more effective and inclusive treatment strategies for patients with this condition. A promising approach being studied is the utilization of community pharmacists to individualize and implement diabetes self-management training and education. The objective of this study is to develop a preliminary version of a patient decision aid (PDA) designed to evaluate patient knowledge and behavior towards diabetes self-management for use in the community pharmacy setting. The study design used to achieve this objective was a cross-sectional survey …

Design, Synthesis, And Biological Evaluation Of Aryl Piperazines With Potential As Antidiabetic Agents Via The Stimulation Of Glucose Uptake And Inhibition Of Nadh:Ubiquinone Oxidoreductase, R. Devine, M. Kelada, S. Leonard, D.S.D. Martin, J.M.D. Walsh, C.J. Breen, R.B. Driver, Gemma K. Kinsella, J.B.C Findlay, J.C. Stephens

Articles

The management of blood glucose levels and the avoidance of diabetic hyperglycemia are common objectives of many therapies in the treatment of diabetes. An aryl piperazine compound 3a (RTC1) has been described as a promoter of glucose uptake, in part through a cellular mechanism that involves inhibition of NADH:ubiquinone oxidoreductase. We report herein the synthesis of 41 derivatives of 3a (RTC1) and a systematic structure-activity-relationship study where a number of compounds were shown to effectively stimulate glucose uptake in vitro and inhibit NADH:ubiquinone oxidoreductase. The hit compound 3a (RTC1) remained the most efficacious with a 2.57 fold increase in glucose …

Evaluation Of Attendance, Patient Satisfaction, Knowledge, And Clinical Outcomes Following Participation In A Group Diabetes Self-Management Education And Support Program In A Primary Care Clinic Setting, Jordan Rauh

Undergraduate Honors Thesis Collection

Introduction: Although group Diabetes Self-Management Education and Support (DSMES) programs have been attempted throughout Community Health Network, no evaluation of the programs had been conducted.

Objectives: The primary objectives of this study were to evaluate attendance, patient satisfaction and change in disease state knowledge following participation in six sessions of a group DSMES program led by a multidisciplinary team. The secondary objective was to evaluate clinical outcomes.

Methods: This retrospective, observational study focused on process improvement evaluating a standardized approach to a group DSMES program beginning in August 2017 within Community Health Network. Eleven courses ran six sessions lasting approximately …

Relationships Among Patient Diabetes Self-Care Behaviors, Depression And Self-Reported Medication Adherence In African Americans With Diabetes, Shu Xiao, Phd, Pharmd Candidate, Monica Woloshin, Bs, Pharmd Candidate, Robin Casten, Phd, Barry Rovner, Md, Ginah Nightingale, Pharmd, Bcop

College of Pharmacy Posters

Objectives

To determine the extent to which self-care behaviors and self-reported medication adherence are related to depression in older African Americans with diabetes who presented to the ED.

Advocate Aurora Apc Grand Rounds Dm Pharm Update 7 2019 Chojnacki.Pptx, Carl Chojnacki

Carl Chojnacki, MBA, MSN, APNP, ANP-BC, AWLS

Injectable Systems For Long-Lasting Insulin Therapy, Kumar Kulldeep Niloy

Theses and Dissertations (ETD)

Diabetes mellitus is one of the major global health problems and the prevalence rate is ever increasing reaching to 48% increase by the year of 2040 causing significant economic burdens. Insulin therapy has been the mainstay of diabetes treatment since its discovery in 1922. However, insulin is an unstable peptide with a half-life of only 4-6 min which poses significant challenge in prolonging duration of action of insulin. Nevertheless, the advances in recombinant DNA technology and protein engineering have enabled the development of several long-acting insulin analogue products which show duration of action up to 42 h. However, these insulin …

The Study Of Prevalence Of Diabetes Mellitus And Its Complications In Hiv Patients In, Leelavathi D. Acharya Dr

Manipal College of Pharmaceutical Sciences, Manipal Theses and Dissertations

Background –Diabetes is a chronic, metabolic disorder that is characterized by resulting from defects in insulin secretion, insulin action or both which will affect the patient Quality of life. Pharmaceutical Care is the responsible provision of drug therapy for of achieving definite therapeutic outcomes that improve the patient‘s quality of life.It contributes to the resolution of medical conditions and can help avoid undesirable outcomes about patient‘s drug therapy problems, resulting in benefits to patients.Objectives –To study the impact of Pharmaceutical care in type 2 diabetic patients in a tertiarycare hospital.Methodology –A prospective interventional study was conducted for a period of …

Effect Of Rurality On Diabetes-Related Hospitalizations In A Small Acute Care Hospital In Jackson County, Indiana, Lindsey Ridlen

Undergraduate Honors Thesis Collection

Patient access to healthcare can be a potentially significant barrier to overall health outcomes, especially when paired with a costly and complex disease state such as diabetes. The purpose of this study was to determine if patients with Type 2 diabetes mellitus living in rural areas of Jackson County experience greater health disparity and more diabetes-related hospitalizations than those living in non-rural areas. The study was conducted at Schneck Medical Center in Seymour, Indiana. A total of 164 patients were included in the final analysis based on the presence of a diabetes-related diagnosis code in the patient’s chart; of these, …

Comparative Effectiveness And Safety Of Non-Vitamin K Antagonists Oral Anticoagulants And Warfarin In Elderly Patients With Non-Valvular Atrial Fibrillation And Diabetes, Siddhi Korgaonkar

Electronic Theses and Dissertations

Results: The matched sample consisted of 4578 patients (2291 in each group). NOACs were found to significantly reduce the risk of stroke/SE compared to warfarin (Hazard Ratio (HR): 0.373, 95% confidence interval (CI): 0.247 - 0.564, p<0.001); but, no significant difference was seen between NOACs and warfarin in terms of reducing the risk of MI (HR: 0.864, CI: 0.594 – 1.257, p=0.446). NOACs were found to significantly reduce the risk of ICH (HR: 0.500, CI: 0.300 – 0.834, p=0.008) and OB (HR: 0.608, CI: 0.424 – 0.870, p=0.007); but no difference was seen in the risk of MGB (HR: 0.862, CI: 0.640 – 1.160, p=0.326) between NOACs and warfarin. NOACs were also found to reduce the risk of all-cause mortality (HR: 0.783, CI:0.656 – 0.873, p=0.007). The composite of effectiveness and safety outcomes, and all-cause mortality was statistically significant proving superior overall effectiveness and safety of NOAC therapy to warfarin therapy in terms of risk reduction (HR:0.685, CI:0.587 – 0.801, p<0.001).

The Next Generation: A Novel Diabetes Elective Course For Pharmacy Students, Catherine Hedigan, Mirna Rezkalla, Matthew Ta, Amy M. Egras, Pharmd, Bcps, Bc-Adm

College of Pharmacy Posters

Background

• 30.3 million people or nearly 10% of the United States are diagnosed with diabetes
• Patients with uncontrolled diabetes often have many clinicians, including pharmacists, to help control their diabetes
• Clinicians that can empathize with patients have shown to improve patient satisfaction and outcomes2
• The Diabetes Immersion elective at Thomas Jefferson University College of Pharmacy is offered to third-year pharmacy students to provide additional knowledge about diabetes through hands-on learning and guest lecturers
• The class emphasizes a well-rounded understanding of diabetes touching on topics that may not otherwise be covered in required courses due to time constraints