Patients with type 2 diabetes mellitus (DM) are known to be at an increased risk for macrovascular complications, and cardiovascular disease (CVD) is one of the greatest drivers of morbidity and mortality in this patient population. Over the past decade, the number of treatment options for type 2 DM has increased. In 2008, the United States Food and Drug Administration mandated an evaluation of cardiovascular (CV) outcomes associated with antihyperglycemic agents. Since that time, the CV risk-benefit profile of many antihyperglycemic treatment modalities have been evaluated; however, results have remained inconsistent. This article will review the literature on the use of pharmacologic therapies in patients with type 2 DM and associated CVD risk, as well as provide recommendations for appropriate treatment selection in this population. Current evidence has demonstrated CV benefits with metformin, select glucagon-like peptide-1 receptor agonists (liraglutide), and sodium-glucose co-transporter 2 inhibitors (canagliflozin and empagliflozin).

Abstract:Objective: To assess whether adherence to amiodarone monitoring differed pre-and post-amiodarone restriction template and implementation of the pharmacist-managed clinic. Design: This was a retrospective chart review study. Setting: A large, academically-affiliated Veteran Affairs Healthcare System providing primary and tertiary care. Patients: 580 patients were identified as having an active prescription for amiodarone for at least 60 days from January 1, 2009 to August 31, 2013 and receiving primary care at the VAAHS (Veterans Affairs Ann Arbor Healthcare System). Results: Nearly all patients had TSH and LFTs at baseline regardless of study group. Significant associations between baseline rates for CXR, ECG, PFT, and ophthalmologic exams were found, with higher rates in the clinic and template arms compared to usual care. Similar patterns for all monitoring outcome rates were also found for both the 6-and 12-month measures. Conclusions: Patients on amiodarone who are followed by a pharmacist-managed clinic or where a restricted ordering template was used had increased compliance with amiodarone monitoring guidelines compared to usual care. Use of a restricted template may be a reasonable option in place of a pharmacist-managed service.