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In the context of the COVID-19 pandemic, researchers investigated how insulin use and glycemic control were associated among patients with type 2 diabetes. 

Pharmacists, Telehealth Could Improve Diabetes Care During Emergencies

Videos

Sustainable reimbursement and policy support are essential for community pharmacies to expand services, integrate care, and improve patient and population health outcomes.

Reimbursement Key to Implementing Social Needs Services in Community Pharmacies

Gaining insight from Walgreens’ senior director of immunizations, Samantha Picking, PharmD, discusses her company’s innovative approaches to boosting vaccination rates.

The Technology, Initiatives Advancing Immunization Services in the US

Investigators found that Opill increased access for patients who were uninsured, identified as Black or Latina, had lower education, and lived in the Southern United States.

OTC Birth Control Improves Access to Contraception for Patients With Structural Barriers

Drug Topics connects pharmacists across retail, health system, and specialty practice with clinical updates, pharmacy trends, and regulatory news.

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IBS in pediatric patients has not been studied much, but new data reveals a possible treatment.

Electrical Nerve Field Stimulation May Help IBS Symptoms in Pediatric Patients

There was a lower probability of initiating psycholeptics and experiencing postpartum psychiatric emergencies in study patients who continued using antidepressants



Continued Antidepressant Use Helps Pregnant Women Manage Severe Mental Illness

Patients experiencing IBS were more likely to self-report a non-celiac gluten sensitivity. 

Relationship Between Non-Celiac Gluten Sensitivity, IBS Identified

Resmetirom also has potential as a treatment for NASH.

Resmetirom Safe, Well-Tolerated in Non-Alcoholic Fatty Liver Disease

Increased Abdominal Pain Risk Associated With Antibiotic Use During First Week of Life

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

Immunization Services Paramount for Community Pharmacy Sustainability

Immunization services in the US have recently risen as the one medical necessity provided mainly at community pharmacy locations, opening the door for greater pharmacy sustainability amid an increasingly concerning financial landscape.

“Ask yourself why you're vaccinating, and if you're not vaccinating, why you're not vaccinating,” Hashim Zaibak, PharmD, told 

. “If you're not vaccinating today, what are the obstacles? Do you need to maybe hire more people, maybe change the workflow?”

According to Zaibak, founder and CEO of Hayat Pharmacy in southeastern Wisconsin, self-inflection is the first step for any pharmacy location or group looking to begin expanding vaccination services, or for locations that aren’t vaccinating to begin with. Aside from the notable benefits of boosting vaccine awareness and uptake among the community, offering immunization services is a sure-fire way to increase revenue opportunities for pharmacy businesses.

“When I think of a good pharmacy, I'm always thinking of a pharmacy that offers good services that will help the patients live healthier and longer, and vaccine is always one of them,” continued Zaibak, who sat down with 

Explore Zaibak’s insightful advice and understand just how important vaccines are to community pharmacy, as well as how crucial community pharmacies and their employees are for vaccine uptake and infectious disease rates in the US.

Community Pharmacy’s Pivotal Role in Boosting Immunization Rates

Are you ready to elevate your pharmacy practice? Sign up today for our 

During National Immunization Awareness Month, Hashim Zaibak, PharmD, provided personal tips for community pharmacies looking to expand their vaccination services.

Sulfonylureas were associated with an increased risk of cardiovascular events in patients with type 2 diabetes (T2D) compared with dipeptidyl peptidase 4 (DPP4) inhibitors, according to data published in 

The study, which found the risk was highest for glipizide, suggests sulfonylureas may not be the best choice of medication for patients with T2D who have moderate cardiovascular disease risk.

Sulfonylureas are affordable and effective glucose-lowering agents used for decades in T2D management. However, concerns remain about their cardiovascular safety, based on data from older trials and observational studies showing a higher risk compared with other medications. Additional drawbacks such as hypoglycemia, weight gain, and reduced durability challenge their use as second-line therapy.

“Patients with type 2 diabetes are at heightened risk of adverse cardiovascular incidents such as stroke and cardiac arrest,” Alexander Turchin, MD, MS, corresponding author on the study, said in a release.

 “While sulfonylureas are popular and affordable diabetes medications, there is a lack of long-term clinical data on how they affect cardiac health in comparison to more neutral alternatives like dipeptidyl peptidase 4 inhibitors.”

Investigators from Harvard Medical School and Brigham and Women’s Hospital conducted a study to compare the risk of cardiovascular events after starting treatment with individual sulfonylureas or DPP4 inhibitors. The comparative effectiveness study included 48165 patients with T2D and moderate cardiovascular risk who were treated at 1 of 10 health systems in the United States between January 2013 and January 2023.

The patients all received metformin monotherapy and then initiated either glimepiride, glipizide, glyburide, or any DPP4 inhibitor, including alogliptin, linagliptin, saxagliptin, or sitagliptin. The primary study outcome was the 5-year risk of a 4-point composite of major adverse cardiovascular events (MACE-4), which included myocardial infarction, ischemic stroke, heart failure hospitalization, or cardiovascular death.

During the study, 18147 patients started glipizide, 14282 started glimepiride, 1887 started glyburide, and 13849 started a DPP4 inhibitor. The study found that over a median follow-up time of 37 months, 6.6% of patients experienced a MACE-4: 2.2% had myocardial infarction, 2.6% had an ischemic stroke, 3% had a heart failure hospitalization, and 0.4% died from any of the conditions. Compared with DPP4 inhibitors, the 5-year risk ratio of MACE-4 was 1.13 for glipizide, 1.07 for glimepiride, and 1.04 for glyburide.

Study limitations included a short median follow-up time, which made it difficult to detect further differences between the medications; the fact that gliclazide was not in use during the study; and the fact that racial and ethnic diversity was limited.

“The potentially different cardiovascular risk between individual sulfonylureas in our study underscores the importance of evaluating each agent in a particular pharmacological class on its own merits,” the authors concluded. “These findings caution against extrapolating results of studies evaluating a single agent to the entire class, and temper concerns about the use of research and development resources for the development of multiple agents in the same pharmacological class.”

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1. Turchin A, Petito LC, Hegermiller E, et al. Cardiovascular events in individuals treated with sulfonylureas or dipeptidyl peptidase 4 inhibitors. 

 2025;8(7):e2523067. doi:10.1001/jamanetworkopen.2025.23067

2. Wang H, Cordiner RLM, Huang Y, et al. Cardiovascular safety in type 2 diabetes with sulfonylureas as second-line drugs: a nationwide population-based comparative safety study. 

3. Study compares common type 2 diabetes drugs, finding higher cardiovascular risk for one medication. News release. Mass General Brigham. July 24, 2025. Accessed August 5, 2025. 

https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/cardiovascular-risk-of-diabetes-drugs

Patients with type 2 diabetes and moderate cardiovascular risk had a higher rate of major heart-related events when treated with sulfonylureas.

Glipizide Increases Cardiovascular Risk Compared With DPP4 Inhibitors in T2D

Metformin, a drug primarily used for the treatment of diabetes, has been thought to provide clinical benefits extending to neurodegenerative conditions, including Alzheimer disease (AD). However, results published in 

 showed that metformin may not be the optimal pharmacologic agent for patients with diabetes who are trying to target neurodegeneration as their primary concern.

“Metformin's use for DM [diabetes mellitus] treatment is generally considered to be a first-line option due to affordability, accessibility, and effectiveness in lowering [hemoglobin] A

, as evidenced here with patients having taken metformin having reduced values when compared to sulfonylureas and short-acting insulins, with differences of 0.1% and 0.56%, respectively,” the study authors wrote.

article, investigators conducted a systematic review and meta-analysis to determine if metformin could prevent cognitive dysfunction, with results showing that the occurrence of cognitive decline decreased for patients with diabetes, but only for the prevention of dementia and not AD. Further, from the authors of a study in 

metformin use did correlate with slower decline on a score of global cognition compared with patients who did not use metformin. However, when examining any diabetes medication, there was no association observed for diabetes medication and cognitive function compared with no diabetes medication.

In the current study, investigators compared metformin, glucagon-like peptide-1s (GLP-1s), insulin, and sulfonylureas for hemoglobin A

, AD development, and mortality. Then they compared the protective value of metformin for patients with diabetes with that of patients without diabetes. Data were included from TriNetX, with investigators including patients who were documented to take one of the drug classes of interest. Patients were older than 50 years.

Analysis group A included metformin compared with GLP-1s, group B included metformin and sulfonylureas, group C included metformin and short-acting insulin, and group D included metformin users with diabetes and metformin users without diabetes. The results showed a significantly higher risk of AD for analysis A, metformin compared with GLP-1s, and there was no statistically significant difference for analysis B or analysis C. As for patients with and without diabetes, the risk of those with diabetes developing AD who were taking metformin was higher than those without, according to the study authors.

Regarding mortality, analysis A indicated statistically insignificant risk differences, and groups B and C demonstrated lower mortality risk. For patients with and without diabetes, the mortality risk was insignificant. When looking at hemoglobin A

, the investigators found that patients taking metformin had a value of 6.53% compared with GLP-1s having 6.28%. Further, for metformin and sulfonylureas, the hemoglobin A

 values were 6.58% and 6.68%, respectively, and for metformin and short-acting insulins, the values were 6.60% and 7.16%, respectively.

“Metformin's neuroprotective effects against AD, compared [with] other treatments, were inconsistent,” the authors concluded. “There was no comparison between analyses A-C, in which metformin demonstrated a protective effect against neurologic decline based on the incidence of an AD diagnosis.”

1. DiGiovanni A, Shehaj A, Millar D, Tse C, Rizk E. Utility of pharmacological agents for diabetes mellitus in the prevention of Alzheimer disease: comparison of metformin, glucagon-like peptide-1 (GLP-1) agonists, insulin, and sulfonylureas. 

New research shows metformin's inconsistent neuroprotective effects against Alzheimer disease, challenging its role in diabetes management for cognitive health.

Kenny Walter

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