Blog Post

Updated Diabetes Guidelines Prioritize SGLT-2 and GLP-1 Medications to Reduce Cardiovascular, Kidney Risk

Introduction

The Centers for Disease Control (CDC) reports more than 38 million Americans – roughly 10% of the population – have diabetes, with most, 90% to 95% diagnosed with type 2 diabetes (T2D). So when new guidance is issued with regard to diabetes prevention and treatment, health professionals, including pharmacists, take note.

What has Changed in the Latest Diabetes Guidelines?

Such was the case in August, when a panel of international experts, writing in the open source BMJ Diabetes Journal, recommended the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists “in all or almost all adults with type 2 diabetes at higher risk of cardiovascular and kidney complications, and in the majority of adults at moderate risk of complications.” For patients at lower risk, the panel advised against routine use of these drugs. Instead, treatment plans should be personalized to address each patient’s unique situation.

Why are SGLT-2 and GLP-1 Medications Being Prioritized?

The panel’s recommendations are noteworthy, explains Pharmacy Times, because they come at time when “the central goal of diabetes management has shifted from controlling blood glucose to preventing cardiovascular and kidney complications.” This change in approach is driven by the fact that T2D affects nearly 500 million people across the globe, and is the ninth leading cause of death, “connected to multiorgan health issues,” the article notes.

Previous research has demonstrated the effectiveness of SGLT-2 inhibitors and GLP-1s such as finerenone and tirzepatide in achieving protective benefits for the heart and kidney, as well as weight loss. The current guidelines make note of this prior research, and offer six recommendations for use of these medications in T2D patients with cardiovascular and kidney complications. Those recommendations include:

Adults with diabetes at higher or moderate risk of cardiovascular and kidney complications: The panel recommends using SGLT-2 inhibitors or GLP-1s.

Adults with diabetes at lower risk of cardiovascular and kidney complications: The panel recommends against the use of SGLT-2 inhibitors and GLP-1s.

Adults with diabetes and chronic kidney disease at higher risk of complications: The panel suggests using the drug finerenone, “as benefits are more likely to outweigh the risks.”

Adults with diabetes and chronic kidney disease at the highest risk of cardiovascular and kidney complications: The panel suggests the use of finerenone.

Adults with diabetes and chronic kidney disease at moderate risk of complications: The panel recommends against the use of finerenone.

Adults with diabetes and obesity: The panel recommends the use of tirzepatide, “irrespective of the patient’s risk of cardiovascular and kidney complications,” because of the drug’s “superior effects” on weight loss.

However, the panel notes that when choosing between GLP-1 receptor agonists and tirzepatide, “clinicians should weigh the higher certainty of cardiovascular and kidney benefits (offered by GLP-receptor agonists) against larger weight loss benefits (offered by tirzepatide) based on a patient’s risk profile as well as their values and preferences.”

How do These Guidelines Impact Pharmacists and Providers?

The panel’s recommendations should be of particular note to pharmacists, who have an important role in helping patients manage their diabetes. While pharmacists have always been responsible for dispensing required medications, a recent analysis in the peer-reviewed journal Diabetes, Metabolic Syndrome and Obesity described the many ways in which their role has evolved. “The pharmacist’s role has changed significantly over the last fifty years. Transitioning from strictly dispensing to providing clinical services that include patient education, direct patient care responsibilities, and chronic disease management through team-based care.” This transition has occurred as healthcare overall has shifted to value-based care, which prioritize the quality of care given to a patient, rather than the volume of medications or services provided.

The pharmacist’s role is so essential to diabetes management, that the American Diabetes Association considers pharmacists essential diabetes care team members. Technology is another important member of the team. Pharmacists rely on their technology management systems, including PrimeRx, to automate and manage critical pharmacy workflows and facilitate important patient services.

Specific to diabetes management, PrimeRx stands apart from other pharmacy management systems, with capabilities that include:

Patient Records Management

PrimeRx allows pharmacists to create and maintain comprehensive patient health records. For diabetes patients, the system maintains a history of each patient’s prescription medications, along with information about any supplements or OTC medications the patient may take. Pharmacists can capture information about a patient’s medical history including diagnosed conditions, lifestyle behaviors, family situation, living situation, and any other information that would add to an understanding of a patient’s profile.

Additional records-related features include:

Planning and goals: The CDC notes that diabetes can often be managed, or even prevented, through lifestyle adjustments including healthy eating and exercise. PrimeRx allows pharmacists to create wellness plans that include mutually agreed upon goals. For example, a diabetes patient might set a goal of taking three or four brisk walks each week, or eliminating desserts. Pharmacists can create a plan within PrimeRx, share the plan with patients, and update the patient’s progress as warranted.

Notes and observations: Pharmacists can update a patient’s record following a consultation, with notes about changes to their condition, or any other relevant information.

Records Maintenance. The system prioritizes recordkeeping and compliance. All documentation, including prescriptions, insurance information, payment records, and signatures, is stored within each patient’s record. Pharmacists can quickly access all records, which is especially helpful in responding to audit requests.

Medication Synchronization. Patient records can be quickly adjusted so that all refills are set for the same day. Allowing patients to obtain all medications during a single trip to the pharmacy – making the process as easy as possible — has proven to be an effective tool in improving medication adherence.

Medication Therapy Management

Medication therapy management (MTM) is defined as “a range of services provided to individual patients to optimize therapeutic outcomes (help patients get the most benefit from their medications) and detect and prevent costly medication problems.”

The National Community Pharmacists Association’s 2024 NCPA Digest found that 81% of independent pharmacies offer medication therapy management (MTM) services. PrimeRx offers comprehensive MTM functionality that includes:

Medication therapy review (MTR): This refers to the process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them.

Personal medication record (PMR): The PMR is a comprehensive record of a patient’s medications, including prescription and non-prescription medications, herbal products, and other dietary supplements. A patient is provided with a PMR – ideally electronically – to assist with overall medication self-management.

Medication-related action plan (MAP): The medication related action plan (MAP) is a patient-centric document that includes a list of actions for the patient to use in tracking self-management progress. The MAP serves as the “plan of action” for helping a patient achieve specific health goals.

Intervention and/or referral: The pharmacist provides consultative services and intervenes to address medication-related problems.

Documentation and Follow-up. Documentation is an essential element of MTM services. The pharmacist documents services and intervention(s) performed in a manner appropriate for evaluating patient progress, and sufficient for billing purposes.

eCare Plans

eCare plans provide a standardized format for documenting the medications and services offered to patients. In addition, eCare plans allow community pharmacists to join with other healthcare providers and payers to collaborate and exchange patient information. Through eCare plans, pharmacists engage with members of a diabetes patient’s healthcare team to ensure consistency of care and to identify any changes needed in medication protocols. In addition, pharmacists have a way to demonstrate the many clinical services offered to patients, which may improve the likelihood of reimbursement.

PrimeRx was among the earliest supporters of the eCare plan concept, and among the first approved technology providers. Pharmacists can quickly create eCare plans within PrimeRx with required functionality that includes:

Medication synchronization programs.

Immunizations.

Personal medication records.

Patient health histories/therapy plans.

Medication goals.

Comprehensive medication reviews.

Medication Procurement

Pharmacists can rely on another PrimeRx solution, PrimeRx MARKET, to ensure steady supplies of prescription medications and diabetes-related supplies at the best possible prices.

PrimeRx MARKET is an online market that allows direct access to more than 40 of the nation’s leading drug wholesalers and suppliers. Pharmacies can identify sources for medications, vaccines, OTCs, injectables and other products, with real-time price comparisons between suppliers.

PrimeRx MARKET integrates directly with the PrimeRx operating system, which allows pharmacies to manage the inventory and procurement processes from any point within the dispensing workflow. Medications can be sourced and orders placed without having to jump to a different screen or log into another system.

PrimeRx MARKET allows pharmacies fast, direct access to needed medications and supplies. Pharmacy staffs can recapture valuable time previously spent manually looking up this information. Less time looking up medications means more time to spend with patients.

Patient Communication

Good communication is essential to the success of a diabetes management program. Pharmacy staff must have options for checking in with patients, and for patients to contact the pharmacy with questions or concerns.

PrimeRx offers extensive communication capabilities through the myPrimeRx.com solution. With myPrimeRx.com, patients are kept informed with real-time SMS delivery updates, notifications about scheduled refills, and personalized reminders including dosage requirements. The system also enables two-way communication, which allows pharmacists and patients to interact about medications and other aspects of a patient’s diabetes management plan.

Two-way communication also facilitates compliance with auto-refill requirements and helps pharmacies promote medication adherence initiatives.

Patient Education

PrimeRx helps patients learn about their prescribed medications through access to the VucaHealth library of educational materials. When patients receive their medications from the pharmacy, each will have a QR code printed on the label. Patients can quickly scan the QR code to access materials including fact sheets, medication guides, and videos that provide detailed, but easy-to-understand, information about each medication.

The latest recommendations regarding the use of SGLT-2 and GLP-1 medications continue the good work to find ways to prevent, and manage, diabetes. Pharmacists, as essential members of diabetes care teams, will ensure patients have access to these and other medications, while offering extensive counseling and educational services. And PrimeRx will also have a role to play, making it easier for pharmacists to help patients manage this very serious condition, and facilitate good patient outcomes.