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In pharmacies in predominantly Black and Latino neighborhoods, only 18% and 17% were likely to carry buprenorphine compared with white neighborhoods.

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Measuring Medication Adherence: Exploring Issues and Better Solutions

journal explores issues within pharmacy, from the impact advocacy can have in community pharmacies to staffing shortages across multiple sectors within pharmacy. This month’s issue also explored the importance of disease awareness months and how they are opportunities to maximize valued care. Check out a preview of this month’s issue here.

download the PDF of the Total Pharmacy August 2024 issue here

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See what’s trending in pharmacy with a preview of the Total Pharmacy August issue.

Total Pharmacy

In This Issue: Total Pharmacy August 2024

Combining sodium glucose co-transporter 2 inhibitors (SGLT2is) with glucagon-like peptide-1 receptor agonists (GLP-1RAs) may offer additional protection against cardiovascular and kidney disease in patients with type 2 diabetes (T2D), according to the results of a new meta-analysis published in 

 and presented at the 61st European Renal Association Congress in Stockholm, Sweden.

Separately, SGLT2is and GLP-1RAs have demonstrated cardiovascular benefits. However, little clinical literature has focused on outcomes associated with using the medicines together. Due to the growing prevalence of GLP-1RAs in the 

 and obesity landscape, accelerated by an increasing number of indications for the agent class, this is a crucial area for further study.

The SGLT2 Inhibitor Meta-analysis Cardio-Renal Trialists’ Consortium (SMART-C) is the largest assessment of outcomes for the combined therapeutic use of SGLT2is and GLP-1RAs. The study gathered data from 12 large-scale, placebo-controlled trials of SGLT2is involving 73,238 patients with diabetes. Of these, 3065 were already receiving GLP-1RAs.

Overall, SGLT2is lowered the risk of major adverse cardiovascular events by 11% and hospitalization for heart failure or cardiovascular death by 23% compared to placebo. Notably, this benefit was seen regardless of whether patients were also taking GLP-1RAs.

When used together with GLP-1RAs, SGLT2is reduced the risk of chronic kidney disease progression by 33% and slowed the annual loss of kidney function by nearly 60%.

The study found no additional safety concerns when SGLT2is were used in combination with GLP-1RAs.

Study Reveals Robust Benefits of Semaglutide in Protecting Against Kidney, CV Events in Patients With T2D

Current meta-analysis results build off positive results of the landmark FLOW trial (

). Published earlier in May, results of the international, double-blind, randomized, placebo-controlled phase 3 trial spotlighted semaglutide’s effectiveness in lowering the risk of kidney failure, decelerating worsening kidney function, and protecting against the risk of cardiovascular events and death, in patients with T2D.

“SGLT2 inhibitors have clear protective effects against heart failure and chronic kidney disease, while GLP-1 receptor agonists can reduce the risk of heart attack, stroke, and also kidney disease—as recently demonstrated in the landmark FLOW trial,” said Brendon Neuen, lead author, clinical associate professor, senior research fellow at The George Institute for Global Health, and director of kidney trials at Sydney’s Royal North Shore Hospital, in a news release.

 “Our findings support using this combination to further improve outcomes in patients with type 2 diabetes who meet guideline recommendations for both therapies.”

Elevated glucose from diabetes can damage blood vessels in the heart and kidneys, increasing the risk of 

 and kidney disease. In fact, diabetes is the most common cause of chronic kidney disease.

Moreover, estimates predicting that T2D prevalence will more than double in the next 30 years, surpassing 1 billion global cases by 2050, further strengthen the need for research into diabetes care.

 According to Neuen in an interview with 

 conducted over email, the current study offers valuable insights for developing global treatment strategies for the condition.

"These findings, which represent the largest and most comprehensive evaluation of the combined use of SGLT2i and GLP-1RA, provides the clearest evidence yet that combined use of both medicines can further reduce cardiovascular and kidney disease," said Neuen. "We anticipate that these findings will inform how people with diabetes are treated worldwide, including influencing major clinical practice guidelines.

Although current results suggest that using SGLT2is and GLP-1RAs in tandem may offer robust protection against cardiovascular and kidney disease, further research is needed to fully understand the long-term effects of the combination therapy.

Pharmacy practice is always changing. Stay ahead of the curve: Sign up for our 

 and get the latest drug information, industry trends, and patient care tips, straight to your inbox.

1. Apperloo E, Neuen BL et al. Efficacy and safety of sodium glucose co-transporter 2 inhibitors with and without glucagon-like peptide-1 receptor agonists: A SMART-C collaborative meta-analysis of randomised controlled trials. 

. 2024. doi: 10.1016/S2213-8587(24)00183-9

2. Massaro L. Study reveals robust benefits of semaglutide in protecting against kidney, CV events in patients with T2D. 

https://www.drugtopics.com/view/study-reveals-robust-benefits-of-semaglutide-in-protecting-against-kidney-cv-events-in-patients-with-t2d

3. Combining popular diabetes drugs offers complementary heart and kidney benefits. News release. The George Institute for Global Health. July 9, 2024. Accessed July 10, 2024. 

https://www.georgeinstitute.org/media-releases/combining-popular-diabetes-drugs-offers-complementary-heart-and-kidney-benefits

4. Mayo Clinic Staff. Chronic kidney disease. Fact sheet. Accessed July 8, 2024. 

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

5. Klein HE. Diabetes prevalence expected to double globally by 2050. 

https://www.ajmc.com/view/diabetes-prevalence-expected-to-double-globally-by-2050

When used together, sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were able to lower the risk of major adverse cardiovascular events and kidney disease by 11% and 33%, respectively.

Clinical

SGLT2i, GLP-1RA Combination Therapy Offers Robust Protection Against Cardiovascular, Kidney Disease

Interdisciplinary teams can help improve glycemic outcomes for patients with diabetes using continuous glucose monitoring (CGM), according to results of a study published in 

 Investigators stated that certified diabetes care and education specialists and clinical pharmacists are essential members of diabetes care teams.

“There is a trend recently where [CGMs] are even more accessible, but historically, we didn't teach this in the [pharmacy] curriculum. We did not teach diabetes technology,” Morgan Stewart, PharmD, BCACP, BC-ADM, clinical associate professor of pharmacy practice at the University of Texas at Austin, 

 “We taught glucometers and point-of-care testing, but diabetes technology really isn't a required component of any current curriculum in our PharmD curriculum.”

Patient education is an important part of improving outcomes while using CGMs. According to the American Pharmacists Association, pharmacists need to be educated on CGM devices and how to interpret their data to help guide patients who are new to these systems. Student pharmacists may learn how to use CGMs in their courses, and practicing pharmacists should continue to learn about newer systems and how to best help patients.

In the current study, investigators aimed to repeat the success of a previous study examining CGMs combined with team-based care in lowering glucose over a 3-month period. The new study included an intensive program using a weekly review of CGM data for lowering glucose levels at 3 months, and whether the results would be maintained at 6 months.

Patients enrolled in the study initially met with an endocrinologist, who prescribed a treatment plan, and then with a clinical pharmacist, who reviewed medication and started counseling on CGMs. Then patients were referred to the diabetes self-management education program that highlighted diet, exercise, medication adherence, and other topics tailored to patients. During the first 3 months, patients were contacted by telephone or electronic message weekly by the pharmacist or physician, which included reviewing CGM data and adjusting pharmacotherapy as needed. After 13 weeks, the patients visited their endocrinologist to make adjustments to their medication and check their hemoglobin (Hb) A

levels. Patients were then contacted by their pharmacist or physician at monthly intervals for 13 more weeks.

Of the 29 patients enrolled in the study, 21 completed the study. Investigators found there were significant improvements in HbA

 levels, average glucose levels, and time in range. Mean HbA

 at 6 months was 7.6%; average glucose decreased from 212.8 mg/dL to 159.5 mg/dL, and time in range increased from 44.5% to 67.7%. As for treatment, sulfonylurea and thiazolidinedione were discontinued for all patients, but metformin and DPP-4 inhibitors remained unchanged. There were also slight increases in the number of patients treated with basal and bolus insulin and notable increases in the number of patients initiating SGLT2 inhibitors or GLP-1 receptor agonists after the program.

“One thing about pharmacists is we are incredibly good about connecting with our community and sharing best practices and resources...starting at the point of pharmacy education [and] integrating these technologies into pharmacy curricula so that new graduates who go out into the workforce have a solid foundation,” Stewart said.

Continuous Glucose Monitoring Resource Center

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1. Behnke A, Lucas KS, Parkin CG, Reddy V, Orlowski M, Edwards A. Persistent performance improvement using team resources and continuous glucose monitoring in patients with poorly controlled type 2 diabetes. 

. 2025;38(3):353-358. doi:10.2337/ds24-0085

2. Meara K, Stewart M. Q&A: training, support key to pharmacist confidence with CGMs. 

. August 20, 2025. Accessed August 26, 2025. https://www.drugtopics.com/view/q-a-training-support-key-to-pharmacist-confidence-with-cgms

3. As CGM evolves, so does the role of the pharmacist. American Pharmacists Association. Accessed August 26, 2025. https://www.pharmacist.com/Blogs/CEO-Blog/as-cgm-evolves-so-does-the-role-of-the-pharmacist

Certified diabetes care and education specialists and clinical pharmacists are essential members of diabetes care teams.

Pharmacist Involvement Improves Glycemic Outcomes With CGMs

Register Today: September 2025 Total Pharmacy Solutions Summit

 event will take place virtually on Saturday, September 13, 2025, from 9:00 AM to 3:00 PM. The summit’s insightful sessions will focus on patient access and education, with key pharmacy industry leaders discussing the opportunities and strategies available to reach patients in the community.

While pharmacies work around the clock to provide life-saving clinical services such as diagnostic testing and immunizations, many patients throughout US communities are unable to take advantage of these services due to a lack of knowledge or pharmacy access. With the help of major players in the pharmacy industry, this fall summit will provide independent pharmacies with the necessary tools to properly engage their patient populations.

“Attendees will learn how to spot barriers they may not have realized were shaping patient outcomes and how to reframe everyday situations, like vaccine hesitancy, from ‘individual failure’ to ‘systemic barrier,’ and how that shift transforms patient trust and engagement,” said representatives from the National Pharmaceutical Association (NPhA). “They’ll also walk away with a new perspective and strategies to help them act as bridge builders, across differences and across generational divides.”

NPhA’s Interim Executive Vice President Shantel Upshaw, PharmD

, will give the keynote session, titled “From Barriers to Bridges: Redefining the Pharmacist’s Role in Reaching Every Patient.” With NPhA representation in this fall’s keynote, Upshaw is poised to empower attendees to move aside from routine practice and explore transformational, person-centered engagement intended to significantly improve the outcomes of each patient in the community.

Other featured speakers include the following:

Jake Galdo, PharmD, MBA, BCPS, BCGP, CEO of Seguridad, Inc

Tripp Logan, PharmD, vice president of SEMO Rx Pharmacies and Care Coordination

, are hosting the first general session, titled “All Pharmacies are NOT the Same.” Touching on the importance of differentiation in the pharmacy business, the duo will discuss ways in which independent pharmacy leaders can help patients choose their pharmacy based on service and care rather than just convenience.

“Patients, payors, providers, and others all think a pharmacy is a pharmacy,” stated Seguridad. “Yet, patients have unequal access to pharmacy services—and pharmacies are paid differently. All pharmacies are NOT the same.”

Dani Markus, PharmD, principal product manager at Outcomes

, will host another general session titled “Powering Patient Engagement Through Access, Education, and the Pharmacy Experience,” focusing on how the Outcomes Clinical Platform is driving innovation, enhancing patient engagement, and empowering pharmacies through advanced clinical capabilities.

Rounding out the final 2 general sessions of the event, representatives from 

 will discuss ways to “unlock hidden profits” and expand pharmacy services in chronic disease, mental health, and reproductive care.

Finally, attendees will have the opportunity to gain CE credits sponsored by 

CE. These 2 sessions—titled “Utilizing Potassium-Competitive Acid Blockers for Acid Peptic Disorder” and “Iron-Deficiency Anemia Treatment Considerations in Women’s Health”—will explore clinical trials, patient-specific factors, screening recommendations, and much more within the women’s health and acid peptic disorder spaces.

“The pharmacy landscape continues to change,” concluded Cardinal Health regarding the insights this fall’s summit will offer. “The 

 Solutions Summit is a great opportunity to gain insights to help pharmacists and pharmacies better navigate these changes, position themselves for success, and deliver value to their patients.”

Click here to register for this can’t-miss event before it’s too late

The event will focus on patient access and education in pharmacy practice, featuring industry leaders providing actionable strategies and real-world solutions for independent pharmacies.

Register Today: September 2025 Total Pharmacy® Solutions Summit

Although dapagliflozin (Farxiga) and empagliflozin (Jardiance) show similar cardiorenal and safety outcomes for patients with type 2 diabetes (T2D), unstable prior angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use could be a factor in the mortality risk of patients receiving empagliflozin, according to recently published study data.

“Both dapagliflozin and empagliflozin demonstrated statistically comparable cardiorenal benefits and safety outcomes, with consistent results across various sensitivity analyses and prespecified subgroups,” the study authors said.

 “In the sensitivity analysis focusing on unstable prior ACEI/ARB exposure, empagliflozin use was associated with an increased risk of all-cause death compared [with] dapagliflozin.”

T2D is a complex disease, with treatment often including physical activity, diet changes, and oral or injectable medications to help meet blood glucose goals. Common symptoms can include frequent urination, feeling thirsty, extreme fatigue, blurry vision, and cuts and bruises that are slow to heal. However, according to the American Diabetes Association, sometimes symptoms are so mild that they are often unrecognized.

 Preventing T2D and treating the condition early on can help prevent or reduce the risk of cardiovascular events and chronic kidney disease.

Dapagliflozin is an oral treatment that helps the kidneys prevent the absorption of glucose and can lower glucose levels. Further, it can be used to lower the risk of hospitalization for heart failure, other cardiovascular diseases, and kidney diseases.

 Empagliflozin works similarly, as it also helps to prevent the absorption of glucose. It is also used to lower the risk of cardiovascular disease for patients with T2D and heart or blood vessel diseases. It can also be used to lower the risk of cardiovascular death and hospitalization for patients with heart failure and lower the risk of worsening kidney disease.

However, caution with empagliflozin use should be applied for patients previously taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

James Lee, Director, Innovation Solutions – Medication Adherence Jones Healthcare Group

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