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Articles

The results of this study show that the concurrent presence of asthma and obesity did not synergistically amplify inflammation in children with both asthma and overweight/obesity.

Overweight, Obesity, and Asthma Independently Increase Expression of Inflammatory Biomarkers

Miudella achieves similar efficacy to other available copper IUDs with less than half the dose of copper.

FDA Approves First Non-Hormonal Copper IUD in Over 40 Years

Among postmenopausal women, researchers investigated the association of cardiometabolic parameters and circulating levels of visfatin, adropin, and adiponectin.

Adiponectin to Predict Cardiometabolic Risk in Postmenopausal Women

The increased risk of symptoms only includes respiratory-related symptoms or brain fog.

Poor Glycemic Control for Patients With Type 2 Diabetes Increases Risk of Long COVID Symptoms

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Strides in Research are Happening for CBD, But More Work is Needed

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

The Cut Hypertension Program was established with the goal of bringing care to underserved communities within the Bay Area of California. Offering hypertension management services for patients and health coach training for barbers, the program’s coordinators have worked to make barbershops in their community a health care setting for all local residents.

“What we're trying to do is bring medicine to the community instead of the other way around,” said Crystal Zhou, PharmD, APh, AHSCP, BCACP. “It could be a barbershop, it could be a nail salon, it could be a church. I think this model of bringing care into the community for the people who need it most is what's really important and could make a huge impact in public health and really improve people's blood pressures.”

Crystal Zhou is the Cut Hypertension Program’s Lead Pharmacist. She sat down with 

 to discuss her role within the program and her team’s overall goals for community engagement. “Our vision is that black barbershops and salons can be places of health promotion and outreach, community building, and treatment for the black community,” according to the 

Stay tuned for more from our conversation with Zhou as she discusses further the role of pharmacists in providing access to care in the community.

: Can you start by discussing what the Cut Hypertension Program is and how it came to be?

 The Cut Hypertension Program is actually a community-based barbershop hypertension management program. The Cut Hypertension team is very, very small right now. It's just myself, the pharmacist. We have a program coordinator and then a lead physician who is our supervising physician. It's basically the 3 of us. We provide training to barbers who work at different barbershops who are interested in participating in our program to provide health coaching to the clients in their barbershops who might have high blood pressure. As part of the program, we provide the health coach training for our barbers, and it's a very dense training, actually, for someone who's not a health care provider. We go over what is blood pressure, what is high blood pressure, how to screen, and actually measure clients’ blood pressures. Also, we provide them some key talking points for what if a client comes in with high blood pressure, what do you say to them? What types of questions do you ask? So that's a major part of our Cut Hypertension Program.

On the other side, we have myself and the program coordinator working actively in the community. Sometimes we'll be doing blood pressure screenings if we're in the barbershops, but mainly my role is to manage hypertension in clients who have high blood pressure, that have been screened positive either by the barbers themselves or the coordinator or myself. What's great about this program is I have a collaborative practice agreement with the lead physician, and I'm able to prescribe medicines. I'm able to order labs for the clients who come in with high blood pressure that I'm actually managing their medications for. I think the program, we try to make it as holistic as possible and connect with their primary care providers as well, so their medical team is also in the loop.

New Drug Review: FDA Approves Tryvio for the Treatment of Hypertension in Combination With Other Antihypertensive Drugs to Lower Blood Pressure

How it came to be is a very interesting question. It took us quite some time to launch the program. I want to say it first started probably in 2018 or 2019. There was this physician that I was put in contact with, Kenji Taylor, MD, who at the time was the chief family medicine resident at [the University of California, San Francisco]. He had already established some relationships with barbershops in San Francisco. There were 2 of them that he was working with. He was teaching the barbers how to do blood pressure screenings. And so really, what he was missing was a pharmacist and a coordinator to get this program rolling and on the road. We were planning up until right about before COVID hit, and our launch date was actually a date in March of 2020. Because of that, we had to delay our program. We didn't go into the barbershops for about a year, actually.

As you know, COVID was a really dark time for many people, but especially barbers, because they couldn't work in person. Some of them were cutting hair in their basements to try to make money. There was no other way they could bring an income for their families. When they reopened, it was a very different scenario. The barbershops were no longer these social spaces where people could come and gather and just hang out, see their friends, meet them. Now, everything is appointment-based. The crowds at the barbershops have significantly decreased. I think now that people are feeling more comfortable with COVID, the crowds are increasing again, but because of all the appointments, we kind of had to shift gears for our Cut Hypertension Program as well and turn it into more of an appointment-based system.

Initially, when we first returned to the barbershops, it was July of 2021. COVID was still such a hot topic of discussion that we actually pivoted. Our program ended up providing COVID vaccines to patients and clients coming into the barbershops. Interestingly enough, I ended up vaccinating a lot of the barbers in the shop that I was at because they just didn't have time to go get their own COVID vaccines. The program has come a long way. Now, we are back to doing more hypertension work and managing hypertension. We've partnered with about 14 barbershops in the Oakland side of the bay area, and we've expanded to about 3, possibly 4, in the San Francisco area.

: Outside of the direct communities that the Cut Hypertension Program serves in California, why might an initiative like this be important for health care or public health as a whole?

I think this program is really just a model for how we can improve preventative services. We're using the barbershop because this has been a tried-and-true published way of improving blood pressure that's been shown in the 

. So, we thought, hey, let's try to repeat the study. Let's try to see if it's sustainable in our community up here in the Bay Area because the study was originally done down in Los Angeles County.

We brought it up here and what we're trying to do is bring medicine to the community instead of the other way around. It could be a barbershop. It could be a nail salon. It could be a church. It could even be a grocery store. I think this model of bringing care into the community for the people who need it most is what's really important and could make a huge impact in public health and really improve people's blood pressures.

: Either within the community you serve, or throughout health care and society as a whole, what are your long-term hopes for the Cut Hypertension Program?

I have many, many long-term hopes. One, I really hope that we can expand the program so that more patients in the community can benefit. We've even talked about maybe moving into nail salons to see if we can screen more women with high blood pressure. [We want to be] expanding the program, hiring more pharmacists who are able and willing to be in this role as an advanced practice pharmacist. Two is really to try to work with the payers on this program. Whether it be, if your patient has hypertension and goes to a barbershop, maybe they provide once-monthly haircut vouchers for that patient. Then, we will be in the barbershop managing their blood pressures while they get their haircuts. This could even expand to diabetes, hyperlipidemia. It could expand to a lot of preventative chronic disease states.

I think that once we have this proof of concept ironed out—we're still trying to gather some data and some numbers for the payers that we're working with—I really think it would be beneficial to just partner long term with these insurance companies. I think some of our biggest barriers right now to holding more health coach trainings and also equipment and paying for the blood pressure machines for the barbershops is just the consistent funding. I think if we could maybe have a contract with some of the payers, that would definitely help with the consistent funding as well.

Crystal Zhou, PharmD, APh, AHSCP, BCACP, discussed her role as Lead Pharmacist of the Cut Hypertension Program. 

Q&A: How Barbershops Are Transforming Hypertension Management

Chris Schaffner, PharmD, is an award-winning pharmacist and cancer survivor who has been serving his community in the Pacific Northwest for over a decade. In a podcast interview, he sat down with 

 to discuss his joint business venture which combines a coffee shop and a pharmacy.

The idea came from one of his colleagues in pharmacy school, and when his pharmacy had the chance to establish a coffee shop of its own, Schaffner jumped on the opportunity.

“We've got a Starbucks on every corner, much like the rest of the country has Dunkin or other chains. But the idea was we wanted to bring the casual atmosphere that coffee provides into the clinical setting of a pharmacy,” he told 

Since opening Schaffner Pharmacy, he and his team have won Best Pharmacy in Skagit County in 2022 and 2023, as well as the 2023 AlignRx Pinnacle Award. And even with his success, Schaffner still sees patient care and community engagement as some of the most important aspects of his operation.

, Schaffner explored numerous topics on both sides of his business. From the inception of his coffee shop and how it has improved sales to the success of his pharmacy and improving the front end of his business, he presented an overview of how his joint business venture is able to operate so ingeniously.

How Coffee Helped This Pharmacy Improve Front-End Sales

You can also find this podcast available on 

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.

In an interview with Chris Schaffner, PharmD, owner of Schaffner Pharmacy and Apothecary Coffee in Sedro-Woolley, Washington, he discussed his unique pharmacy operation with the help of coffee shop revenue.

How an Independent Pharmacist Incorporated Coffee into His Pharmacy

With an estimated 75 million Americans living in areas of primary workforce shortages, health care experts and providers around the country are teaming up to address the issue. In a push to utilize the expertise of multiple providers, health care professionals believe it is necessary for pharmacists, physicians, and various other providers to work together in a team-based setting to ensure better outcomes and alleviate shortages.

“When we really think about the provider, the pharmacist [should] not [be] left out of that dialog, because we saw that also during the pandemic,” said Jonathan Watanabe, PharmD, MS, PhD, BCGP. “Pharmacists took on this heroic role, but that role, that emotional toll, the time, and the fatigue, those components weighed heavily. We have to be really strategic about incorporating that, otherwise the gains that we're going to have, potentially for pharmacists being involved, are going to be short lived.”

Watanabe was a contributing author for the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast. The section he co-authored, titled “Addressing the Gap in Primary Care,” focused on identifying gaps within the primary care workforce, possible legislation to alleviate the issue, and the role pharmacists can play within a team-based practice to address shortages.

“How do we make sure that we make pharmacists whole for these contributions that they're making to primary care? I think a lot of that really needs to be looked at and there's groups that are doing it, but I think we need to enhance that,” he continued.

Listen to our full conversation with lead Pharmacy Forecast author Jonathan Watanabe as he discusses the scope of pharmacists’ practice, highlighting past instances of their unique skills within the community and their future potential to be key players within a primary care team.

“I think we're getting better at understanding how collaborative practice agreements can be best developed to maximize. I think it's almost the implementation science of it is now becoming very important. We know that it works, but how to do it in a way that's going to meet the needs of the setting, of the population, that we could show the benefit.”

Stay tuned for weekly podcast episodes on Over the Counter every Thursday afternoon. Check out our previous episode with 

, who also played a part in the 2025 Pharmacy Forecast as leading co-editor. In our ongoing podcast series on the ASHP 2025 Pharmacy Forecast, DiPiro introduced the industry-encompassing report and why it’s such a crucial resource for health-system pharmacy.

DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation Pharmacy Forecast 2025: Strategic planning guidance for pharmacy departments in hospitals and health systems. AJHP. 2024;82(2). doi.org/10.1093/ajhp/zxae280

Jonathan Watanabe, PharmD, MS, PhD, BCGP, discussed gaps within primary care in the context of the American Society of Health-System Pharmacists 2025 Pharmacy Forecast.

Health System

Team-Based Care Crucial in Addressing Workforce Shortages

For pharmacists in both academic and practice settings, it’s important to stay ahead of the curve and keep up with the dynamic landscape of their profession. While it can be hard for them to juggle continued pharmacy education and day-to-day tasks behind the counter, the American Society of Health-System Pharmacists (ASHP) bridges that gap with its annual Pharmacy Forecast report.

The ASHP Pharmacy Forecast is “written to identify and contextualize emerging trends that will influence health care, health systems, and the pharmacy profession.” This year’s report delved into several key areas impacting the pharmacy profession, including generative artificial intelligence (AI), addressing health care workforce shortages, and so much more.

“We begin with a group of advisory committee members…who are experts in various aspects of the pharmacy field and enterprise,” said Joseph DiPiro, PharmD, FCCP, FAAAS. “They help us decide what domains to pursue. Then, a survey is constructed that goes out to 300 leaders in pharmacy around the country. The other parts of this survey [are] given to chapter authors who put together an analysis and interpretation from the survey results and put their spin on it as well. The final part of it is each of the chapters [have] recommendations that are meant for pharmacy leaders.”

Joseph DiPiro is a Professor in the Department of Pharmacotherapy and Outcomes Science at the Virginia Commonwealth University School of Pharmacy and he was one of the leading co-editors of the 2025 Pharmacy Forecast. He recently sat down with 

 to discuss overarching themes in this year’s report and why it’s such a useful resource for pharmacists looking to succeed in a challenging profession.

, President of the National Community Pharmacists Association’s (NCPA) Innovation Center. He discussed NCPA’s brand-new consortium for government engagement and how independent pharmacies are crucial resources during public health crises.

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

DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation Pharmacy Forecast 2025: Strategic planning guidance for pharmacy departments in hospitals and health systems. 

. 2024;82(2). doi.org/10.1093/ajhp/zxae280

Joseph DiPiro, PharmD, FCCP, FAAAS, broke down the importance of the ASHP Pharmacy Forecast and the process in which its content is curated.

Jill Murphy, Assistant Editor

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