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All 3 types of virtual diabetes self-management interventions lead to better results in hemoglobin A1c over a 6-month period.

Virtual Self-Management Tools Can Reduce Blood Sugar in Type 2 Diabetes

A HealthDay Harris Poll highlights the most recent feelings patients have towards vaccines amid outbreaks of vaccine-preventable illness and changes at the federal level impacting public health policy.

Media Coverage, Local Outbreaks Changing Views on Vaccine Hesitancy

Glucocorticoid use for severe community-acquired pneumonia has been controversial due to the safety profile of these drugs.

Glucocorticoids May Reduce Mortality for Community-Acquired Pneumonia

Pharmacists can help manage complications from long COVID-19, as no
medications can treat it.

Effects of Long COVID on Heart Health Remain Unknown

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Oncologists recognize the potential of artificial intelligence (AI) in improving the quality of care and patient outcomes according to new research.

Optimism for AI in Cancer Care

The 2018 oncology drug market had a record number of new treatments and continued a trend of growth.

Oncology Market Remains Robust, Says Report

How targeted therapy could be the pathway to improved cancer treatment.

4 Ways Precision Medicine Impacts Cancer Treatment

Study validates benefits of pharmacists on healthcare teams.

Pharmacist-Driven Intervention Program Reduces Readmissions

Pharmacists should prepare to advise patient consumption methods and THC drug interactions as use and manufacturing models continue to grow and legalize.

Prescription Counseling Equally Applicable to THC Products

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.

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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.

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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

She also discusses the risk factors and consideration for cannabis use disorder

Expert Discusses Potnetial Rescheduling of Cannabis

Cannabis use disorder presents a complex landscape of risk factors and clinical considerations, with experts highlighting the nuanced nature of potential dependency. While the overall risk of developing cannabis use disorder remains relatively low at around 9%, certain populations face significantly higher chances of addiction, according to Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of South Carolina. Younger users, particularly those who begin cannabis use early, can experience up to a 16% risk of developing a use disorder. The risk escalates dramatically with daily, high-dose consumption, potentially reaching 30%.

Franson emphasizes the critical need for more precise definitions surrounding cannabis use disorder. Current research suggests that the risk is relatively consistent across recreational and medical users, indicating that dosage and consumption patterns may be more influential than the user's intention. She also advocates for a comprehensive approach to managing potential substance use disorders, recommending a 4-fold clinical strategy: assessing patient history, recommending lower-risk cannabis variants like CBD, implementing frequent monitoring, and being prepared to advise against cannabis use when risks are too high.

Additionally, Franson further highlights the potential role of pharmacists in cannabis regulation and patient safety. With potential rescheduling of cannabis to Schedule III, there's an opportunity for pharmacists to reclaim their traditional health care role by providing expert guidance on safe cannabis use. She discusses existing federal laws that could enable pharmacists to dispense nonFDA-approved cannabis products, potentially creating a structured framework for responsible distribution and patient education. This approach could help mitigate risks associated with unregulated cannabis consumption while ensuring patients receive professional, evidence-based advice about their cannabis use.

"This is probably the ultimate area for [pharmacists] to get involved in because then we are seizing and saying, 'Hey, don't worry about it. We'll take responsibility of identifying appropriate products that we know the dosages of how much you're getting [and] what's in it to really give the patients the ultimate health care experience when they're trying to use cannabis for health," Franson said.

Read more from our coverage of the American Pharmacists Association 2025 Annual Meeting and Exposition

Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of South Carolina, discusses the risk factors and considerations for cannabis use disorder.

Expert Discusses the Potential Rescheduling of Cannabis | APhA 2025

However, there are also risks involved with the use

Research supports cannabis use for specific disease states

The FDA's recent literature review reveals nuanced insights into cannabis's therapeutic potential across various medical conditions. While the research supports cannabis use for specific scenarios like anorexia secondary to HIV or cancer, nausea and vomiting from chemotherapy, and neuropathic pain, it also highlights significant limitations, according to Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of South Carolina.

Neuropathic pain treatment shows moderate relief using THC-type cannabis at doses between 2 and 10 milligrams, though it's not recommended for acute pain management due to potential complications. Franson emphasizes the complex pharmacological profile of cannabis, particularly distinguishing between THC and CBD types. THC-type cannabis can produce notable adverse effects, including increased heart rate, dizziness, euphoria, and potential anxiety or panic attacks. CBD-type cannabis generally demonstrates better tolerance at lower doses, with minimal adverse effects. However, long-term use of THC-type cannabis raises substantial concerns, including potential development of cannabis use disorder, cannabis hyperemesis syndrome, decreased sperm count in males, and increased risks of psychosis and depression.

Most critically, the research unveils significant cardiovascular and mental health risks associated with cannabis use. Epidemiological data indicates nearly 50% increased risk of myocardial infarction, 2-fold stroke risk, and small increases in arrhythmias. Mental health considerations are particularly nuanced, with heightened risks for individuals with pre-existing substance use disorders, depression, or anxiety.

A particularly alarming finding involves patients with major depressive disorder using cannabis: while providing temporary symptomatic relief, long-term use can paradoxically worsen underlying depression, creating a potentially dangerous reinforcement cycle. Franson underscores the importance of health care providers carefully evaluating individual patient contexts, monitoring long-term cannabis use, and maintaining a cautious, informed approach to its therapeutic application.

"Let's say [a patient] got depressed; they would utilize cannabis, and if they smoked it, 20 minutes later, they're feeling better, right?" Franson said. "What [researchers] found is, over the months that they were following these patients, that their baseline symptoms continued to decline over time."

Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of South Carolina, discusses the risks associated with cannabis use.

Research Supports Cannabis Use for Specific Disease States | APhA 2025

Independent pharmacists stepped up to personalize patient care during the COVID-19 pandemic

Expert Discusses the Impact of Independent Pharmacies

During the COVID-19 pandemic, pharmacists played a crucial role in adapting to rapidly changing information and supporting their communities. Tom DePietro, PharmD, owner of DePietro's Pharmacy, highlighted how their pharmacy leveraged social media as a primary communication tool, providing daily updates that were both educational and engaging. They went beyond traditional information sharing by hosting live talks with local officials, which helped bring levity to a stressful time and kept customers informed about critical health guidance.

The pandemic underscored the unique value of independent pharmacies in delivering personalized healthcare. Unlike large chain pharmacies or mail-order services, independent pharmacies offer personal, local, and in-person care. DePietro emphasized that their ability to build relationships with customers and provide individualized attention is something that cannot be replicated by larger health care systems. This personal touch became especially important during the pandemic, when they proactively reached out to home delivery patients, particularly seniors, to ensure their needs were met.

DePietro also highlighted the broader implications for pharmacists' roles in healthcare. The pandemic demonstrated pharmacists' capacity to provide immediate healthcare access and preventative services, such as vaccine deployment. He argued that pharmacists are uniquely positioned as health care providers, offering instant face-to-face consultations unlike other medical professionals who require appointments or waiting times.

However, he also addressed significant challenges in the health care system. DePietro called for payment reform, noting that current models force pharmacies to fill thousands of prescriptions with minimal profit margins, leading to potential staffing shortages and increased work stress. They urged consumers to become advocates for systemic change, emphasizing that the current health care structure is unsustainable. Ultimately, pharmacists are adaptable, essential health care providers who proved their value during the COVID-19 pandemic and continue to seek recognition and support for their critical role in community health.

"There's no other profession that you could get or obtain immediate access to a health care provider. [The c]losest you can get to a pharmacist is probably an urgent care," DePietro said. "You could literally walk into any pharmacy today and ask to speak to the pharmacist, and the pharmacist is going to walk over and look you in the face. There's no other health care provider that is positioned like a pharmacist."

Tom DePietro, PharmD, owner of DePietro's Pharmacy, highlights how their pharmacy leveraged social media, providing daily updates that were both educational and engaging.

Independent Pharmacies Provide Personalized Care During COVID-19

Immunization with an mRNA COVID-19 vaccine is linked with a lower likelihood of developing long COVID in children and adolescents between the ages of 5 and 17 years, according to data published in 

The authors of the study said the findings suggest that all children and adolescents should stay up to date with current COVID-19 vaccine recommendations.

In the United States, 1.3% of children between the ages of 0 and 17 have ever had long COVID.

The data, which comes from the National Center for Health Statistics, shows that girls are more likely than boys to experience the condition, and those aged between 12 to 17 were more likely to have ever had it compared to younger children. Long COVID in children and adolescents is typically characterized by symptoms like dizziness, an increased heart rate, and fatigue. It can impact multiple organ systems, including the heart, brain, and lungs.

Vaccine Review Can Help Pharmacists Raise Awareness, Promote Immunizations

“Given the potential number of children infected by SARS-CoV-2 and therefore at risk of developing [long COVID], understanding factors that reduce the occurrence and severity of [long COVID] is essential,” the authors wrote. “While data from adult studies show that COVID-19 vaccination is associated with a reduced risk of [long COVID], data on the impact of COVID-19 vaccination on [long COVID] in children are limited.”

A team of investigators from the CDC conducted a study to evaluate the odds of long COVID among children and adolescents who were vaccinated against COVID-19 before an infection with SARS-CoV-2. Data for the study was gathered from the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study, a longitudinal prospective study that aimed to assess SARS-CoV-2 incidence and COVID-19 vaccine effectiveness against infection in those aged between 6 months and 17 years.

For the new analysis, the study cohort included 622 patients who enrolled in the PROTECT study between July 2021 and September 2022. Of those, 28 were case patients and 594 were control patients. Patients were included if their first confirmed SARS-CoV-2 infection occurred during the study period, if they had completed a long COVID survey 60 days or more from the positive SARS-CoV-2 test, and if they were eligible for vaccination at the time of their positive test.

For immunization status, 16 case patients and 458 control patients were vaccinated, with 99% having received the Pfizer-BioNTech BNT162b2 vaccine. Compared to unvaccinated patients, a higher proportion of vaccinated patients reported having 4 or more symptoms during their acute SARS-CoV-2 infection, had no daily medication use, and reported excellent or very good health at baseline.

The study found that COVID-19 vaccination before a SARS-CoV-2 infection was associated with 57% lower odds of 1 or more long COVID symptoms, 73% lower odds of 2 or more long COVID symptoms, and 72% lower odds of long COVID respiratory symptoms. Additionally, vaccination was also associated with a 75% reduced likelihood of long COVID symptoms that impact daily functioning. The authors noted that because the case and control patients all had an infection with SARS-CoV-2, the protection against long COVID from vaccination is likely higher.

“The data from this study are important as they indicate that even in a population that typically experiences only mild COVID-19, vaccination is associated with lower odds of [long COVID], the authors concluded. “Pediatric COVID-19 vaccine uptake in the US has been relatively low, particularly in younger children. Surveys have shown that one reason behind parental COVID-19 vaccine hesitancy is the idea that COVID-19 in children is usually a mild illness and therefore vaccination is not necessary. However, even mild or asymptomatic SARS-CoV-2 infection can result in postinfectious sequelae.”

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1. Yousaf AR, Mak J, Gwynn L, et al. COVID-19 Vaccination and Odds of Post–COVID-19 Condition Symptoms in Children Aged 5 to 17 Years. 

 2025;8(2):e2459672. doi:10.1001/jamanetworkopen.2024.59672

2. Vahratian A, Adjaye-Gbewonyo D, Lin JS, et al. Long COVID in children: United States, 2022. NCHS Data Brief, no 479. Hyattsville, MD: National Center for Health Statistics. 2023. DOI: 

3. Characterizing long COVID in children. News Release. National Institutes of Health. February 17, 2024. Accessed March 11, 2025. 

https://www.nhlbi.nih.gov/news/2024/characterizing-long-covid-children

COVID-19 vaccination before a SARS-CoV-2 infection was associated with a 75% reduced likelihood of long COVID symptoms that impact daily functioning among patients between the ages of 5 and 17 years.



Tracey Walker

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