PHARMACY

Compliance today saves dollars tomorrow, and pharmacy is here to help

BY Michael Johnsen

WHAT IT MEANS AND WHY IT’S IMPORTANT — Life doesn’t give you too many of those Magic 8 Ball moments, at least not the kind you can find at the pharmacy counter. Just ask the 8 Ball if medicine compliance is important for retail pharmacy, and the answer undoubtedly will come back, “It is decidedly so.”

(THE NEWS: Surgeon general, NCL introduce Script Your Future campaign. For the full story, click here)

Everyone knows that compliance today saves dollars tomorrow. The question is whether or not stakeholders — from the payers down to the patients — realize that the most accessible compliance tool is the white-coated healthcare professional who just adjudicated that prescription.

The fact is, if you increase compliance to prescription regimens, people are healthier for it to the tune of $290 billion in annual savings. And the pharmacy counter is just about the best place to realize those savings.

And that means the Script Your Future campaign could become the straw that stirs that value-of-pharmacy-awareness concoction. Ask the Magic 8 Ball what the chances of that are, and the answer very well may be, “Without a doubt.”

Because if you take a look at the list of sponsors and partners of the program, there certainly are a number of pharmacy influencers on the list, including pharmacy operators CVS Caremark, Kerr Drug and Walgreens.

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PHARMACY

Researchers find TZDs may pose certain health risks for diabetics

BY Michael Johnsen

MARYLAND HEIGHTS, Mo. — According to a report in the May issue of Cell Metabolism, while drugs known as thiazolidinediones, or TZDs, are widely used in diabetes treatment, they have effects on the kidneys that lead to fluid retention as the volume of plasma in the bloodstream expands.

"TZDs usually increase body weight by several kilograms," stated George Seki of the University of Tokyo. "However, TZDs sometimes cause massive volume expansion, resulting in heart failure."

The findings may lead to the development of improved diabetes therapies.

TZDs act on a hormone receptor known as peroxisome proliferator-activated receptor γ. PPARγ is a master gene of fat cell biology and differentiation, Seki explained, making it an ideal target for diabetes treatment.

However, TZDs also lead to changes in gene expression that enhance the sodium transport system of the kidney and lead to the reabsorption of water and salt, as scientists knew. But, Seki said, that mechanism alone didn’t seem to be enough to explain the volume expansion.

Seki’s team has found that TZDs also have direct effects on channels in the kidney known as the proximal tubules. TZDs rapidly stimulate sodium-coupled bicarbonate absorption from renal proximal tubules. Inhibitors of PPARγ or other players in the pathway suppress that stimulation, they reported.

The discovery helps to explain the speed with which side effects of TZDs sometimes can arise, and may lead to strategies to improve insulin resistance without the accompanying severe cardiovascular side effects, the researchers noted. "Massive volume expansion in human subjects usually occurs after weeks of use of TZDs," they wrote. "However, it can also occur as rapidly as four days after use of TZDs, supporting the involvement of multiple mechanisms. Thus, combination therapy with different diuretics targeting both renal proximal tubules and the distal nephrons could be a therapeutic option in case of TZD-induced massive volume expansion."

The findings also raise the possibility that other small molecules might bind PPARγ in slightly different ways, leading to different biological responses, the researchers added. In fact, several selective PPARγ modulators already have been developed and appear to induce less fluid retention, at least in animals. Whether that will prove to work in humans to prevent massive fluid retention remains to be seen.

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Study finds link between insomnia, high insulin resistance among diabetics

BY Allison Cerra

NEW YORK — Diabetics that have trouble sleeping likely experience high insulin resistance and have a more difficult time controlling the disease, according to study findings published in the June issue of Diabetes Care.

Researchers said they monitored the sleep of 40 subjects with diabetes for a duration of six nights and also measured the subjects’ insulin and glucose levels during clinical examinations. The subjects also reported if they generally suffered from symptoms of such sleep disturbances as insomnia, snoring or sleep apnea.

Among the diabetics, poor sleepers had 23% higher blood-glucose levels in the morning, as well as 48% higher blood insulin levels. Using these numbers to estimate a person’s insulin resistance, the researchers found that poor sleepers with diabetes had 82% higher insulin resistance than normal sleepers with diabetes.

The data was collected as part of the CARDIA study, an ongoing longitudinal study of the heart health that is supported by the National Heart, Lung and Blood Institute. It has tracked thousands of people for more than 20 years, study investigators said.

"Poor sleep quality in people with diabetes was associated with worse control of their blood-glucose levels," said Kristen Knutson, assistant professor of medicine and lead author of the study. "People who have a hard time controlling their blood-glucose levels have a greater risk of complications, they have a reduced quality of life and they have a reduced life expectancy."

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A.KV says:
Jul-11-2013 08:34 am

Insomnia is one of the easiest conditions to treat with hypnosis. In fact causing someone to fall asleep while in hypnosis so easy it can be a concern to hypnotherapists! That’s right. If you are in hypnosis and you are tired it is very likely you will fall asleep if certain steps are not taken to keep you awake. hypnotherapist singapore

ved12 says:
Jan-18-2012 04:02 am

sleep disorder in diabetics was associated with worse control of their blood-glucose levels. After reading this post we can understand that diabetic people who have unable to control their blood-glucose levels can increase the risk of difficulties in diabetes, and also show the bad effect on their health. What is insulin

R.RHYNE says:
Aug-08-2011 12:30 pm

These are important findings and offer a relatively simpler and solvable issue, insomnia, as a means of improved blood glucose levels, reduction in complications and extended life expectancy for diabetic patients. Actigraphy, from Fatigue Science, may offer an objective, simple, affordable technology for patients to monitor the quality and quantity of their sleep.

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