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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

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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

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Pharmacies face mounting challenges amid increased competition, rising operational costs, and complex reimbursement models.

Strategies for Independent Pharmacies to Harness Consumer Trends and Meet the Competition

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

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

From barely having the capacity to administer influenza vaccines to becoming a premier destination for immunization services, community pharmacies have proved they can be the authority on providing vaccines while also keeping patients safe and protected against infectious disease.

“More than 90% of the vaccines we administered before the pandemic were influenza vaccines,” said Hashim Zaibak, PharmD, founder and CEO of Hayat Pharmacy in Wisconsin. “We gave over 100,000 COVID-19 vaccines in this building [during the pandemic]. People started to recognize...that pharmacists can vaccinate and administer other vaccines.”

to discuss his pharmacy’s journey throughout the COVID-19 pandemic and how immunization services have expanded at his pharmacies. As the CEO of Hayat, Zaibak oversees operations for 19 community pharmacy locations across southeastern Wisconsin.

He joined us to discuss immunization services at his pharmacies, trends he has seen over the past few years, and ways in which other community pharmacies can get involved and advance immunization initiatives.

Stay tuned for weekly podcast episodes on 

every Thursday afternoon. Check out our previous episode with 

, who discussed the detrimental impacts pharmacy deserts have on rural and urban communities across the US.

As researchers continue to measure the impacts of the COVID-19 pandemic on public health, Hashim Zaibak, PharmD, discusses the evolution of community pharmacies in a postpandemic world.

Total Pharmacy Interviews

Community Pharmacy’s Pivotal Role in Boosting Immunization Rates

Mindfulness-based interventions may help improve symptoms of menopause and quality of life, according to new data published in the 

 The authors said that more rigorous randomized trials are needed because the exact mechanisms of how the interventions work remain unclear.

In 2025, over 1 billion women worldwide will be postmenopausal. Menopause is linked to significantly lower health-related quality of life and increased work impairment. Vasomotor symptoms, such as hot flashes, are among the most common and disruptive. More than 75% of women report moderate to severe symptom-related challenges at work, and 44% have taken undisclosed sick leave due to menopause-related issues, highlighting its widespread impact on well-being and productivity.

“Mindfulness-based interventions are easily accessible and require minimal qualifications for intervention providers, making them conducive to widespread implementation in real-world settings,” the authors wrote. “Mindfulness practices enable menopausal women to develop a clear, undistorted awareness of their internal and external experiences. This enhanced awareness helps them better manage the physical and emotional fluctuations associated with menopause, fostering a more balanced response to both pleasant and unpleasant symptoms.”

A team of investigators conducted a study to examine the effectiveness of mindfulness-based interventions on health outcomes in menopausal women, including menopausal symptoms, quality of life, sleep quality, anxiety, stress, and depressive symptoms. The systematic review included a search of 8 databases for randomized controlled trials published until November 2024.

The study included 19 randomized controlled trials published between 2011 and 2024, including 1670 patients across 7 countries. Researchers found that mindfulness-based interventions had statistically significant effects on menopausal symptoms, sleep quality, anxiety, depressive symptoms, and stress. The researchers also found that mindfulness-based interventions had an adherence rate of 79%, demonstrating that they are highly accepted by patients.

“This systematic review and meta-analysis support using mindfulness-based interventions to improve health outcomes in menopausal women,” the authors concluded. “Rigorous randomized controlled trials with extended follow-up are needed to elucidate the mechanisms linking mindfulness-based interventions to menopausal health and strengthen evidence for clinical application.”

, community pharmacists are well positioned to increase the availability of mindfulness-based interventions because of their greater accessibility compared with primary care providers, particularly in rural areas.

 While there is currently a lack of data on the implementation of mindfulness-based interventions in community pharmacies, some research findings have shown that a mindfulness meditation program provided by a pharmacist in the community setting can help reduce the severity of depression and anxiety.

Pharmacists Play Key Role in Expanding Access to Medication Abortion

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1. Wang H, Wang H, Kwok JYY, et al. The effectiveness of mindfulness-based interventions on menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. 

https://doi.org/10.1016/j.jad.2025.04.029

2. Huang DR, Goodship A, Webber I, et al. Experience and severity of menopause symptoms and effects on health-seeking behaviours: a cross-sectional online survey of community-dwelling adults in the United Kingdom. 

. 2023;23(1):373. doi:10.1186/s12905-023-02506-w

3. Harris K, Jackson J, Webster H, et al. Mindfulness-based stress reduction (MBSR) for chronic pain management in the community pharmacy setting: a cross-sectional survey of the general public's knowledge and perceptions. 

(Basel). 2023;11(5):150. doi:10.3390/pharmacy11050150 

4. Perepelkin J, Antunes K, Boechler L, et al. Providing mindfulness meditation for patients with depression and anxiety in a community pharmacy: a pilot study. 

. 2019;59(2):258-264. doi:10.1016/j.japh.2018.10.017 

Women who received mindfulness-based interventions experienced improved sleep quality and reduced anxiety, depressive symptoms, and stress.

Mindfulness-Based Interventions May Improve Menopause Symptoms

Women who have been diagnosed with premenstrual disorders are at an increased risk for developing cardiovascular diseases (CVDs), according to data published in 

Authors of the study said the findings suggest health care providers should be aware of the heightened risk when treating women with premenstrual disorders.

Premenstrual disorders include premenstrual syndrome and premenstrual dysphoric disorder. They are marked by recurring emotional and physical symptoms before menstruation and impact a significant number of women. Although the exact causes remain unclear, research data point to an abnormal sensitivity to natural hormonal fluctuations as a key factor, underscoring the complex and often underrecognized impact on women’s health and quality of life.

“CVDs are the leading cause of mortality among [women],” the authors wrote. “Beyond CVD risk conferred by traditional risk factors, women may face an additional risk attributable to reproductive history. However, current efforts did not adequately capture female-specific risk factors, and identification of more female-specific risk factors may help improve risk profiling and prediction of CVDs among [women].”

A team of investigators from the Institute of Environmental Medicine at the Karolinska Institutet conducted a cohort study to examine the association between premenstrual disorders and the subsequent risk of CVDs. Data for the study were gathered from national registers in Sweden from 2001 to 2022. A sibling cohort was included to address familial confounding.

The study cohort included 99,411 women with premenstrual disorders in the population cohort and 36,061 in the sibling cohort. The median age was 35.4 years for the population cohort and 34.6 years for the sibling cohort. Women with premenstrual disorders were more likely to have a higher educational level, higher parity, and a higher prevalence of disease history, and were also more likely to use hormonal contraceptives or hormone replacement therapy.

The researchers found that women with premenstrual disorders had a higher risk of developing any CVD than women without premenstrual disorders. A stronger association was seen in women with premenstrual disorders that started before the ages of 25, 30, and 35, and in those who had perinatal depression. Similar results were also seen across the sibling cohort.

The most common forms of CVD among the women with premenstrual disorders included hypertensive diseases, essential hypertension, ischemic heart disease, cerebrovascular disease, ischemic stroke, and arrhythmia. The strongest associations were found for arrhythmia in the population cohort and for ischemic stroke in the sibling cohort.

“Our results need to be replicated in other populations, and health care professionals can be aware of the potential CVD risk when managing women with premenstrual disorders,” the authors concluded. “In addition, if the results are confirmed in other populations, premenstrual disorders may be considered as a factor for future CVD risk stratification and prediction among women in the real world.”

“We hope that our findings will contribute to greater awareness that premenstrual disorders not only affect daily life but can also have consequences for long-term health,” Donghao Lu, an author of the study, said in a news release.

1. Yang Y, Bränn E, Zhou J, et al. Premenstrual disorders and risk of cardiovascular diseases. 

 (2025). https://doi.org/10.1038/s44161-025-00684-4

2. Premenstrual symptoms linked to increased risk of cardiovascular disease. News release. Karolinka Institutet. July 11, 2025. Accessed July 14, 2025. https://news.ki.se/premenstrual-symptoms-linked-to-increased-risk-of-cardiovascular-disease

Investigators said they hope the findings contribute to greater awareness that premenstrual disorders can have long-term health consequences.

Premenstrual Disorders Are Linked With Increased Cardiovascular Disease Risk

There is a high prevalence of depressive symptoms among woman who are diagnosed with premature ovarian insufficiency (POI), according to recent data published in 

 The authors of the study said the findings highlight the need for targeted mental health support that addresses the unique needs of this patient population.

POI is characterized by impaired ovarian follicle function before the age of 40 and affects approximately 3.7% of women worldwide. In addition to fertility challenges, POI increases the long-term risk of bone loss, cardiovascular disease, and cognitive decline. Although many cases remain idiopathic, evidence increasingly supports a strong genetic basis, with the age of menopause recognized as a heritable trait.

Women with premature ovarian insufficiency experience a high prevalence of depressive symptoms, highlighting the need for comprehensive, multidisciplinary care.

Peter Koo, PharmD

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