Pharmacist management of patients with type 2 diabetes significantly influenced clinical and economic outcomes in an uninsured population living in a rural area with few health care resources.

BackgroundAntimicrobial lock therapy (ALT) may be considered as adjunctive therapy in the treatment of catheter-related bloodstream infections (CRBSI) when catheter removal is not a favorable option.ObjectiveTo evaluate the outcomes associated with ALT as adjunctive treatment of CRBSI.MethodsThis was a 24-month retrospective case series analysis evaluating patients treated for more than 24 hours with ALT. The primary outcome was blood culture sterilization for 30 days posttherapy. The impact of ALT duration and time to initiation on central venous catheter (CVC) salvage were evaluated. Logistic regression modeled the association between ALT and sterilization rates, with a prespecified level of significance (α) of 0.1.ResultsTwenty-six cases were included in data analysis. Patients included ranged from 5 months to 82 years of age; 77% of patients were receiving total parenteral nutrition or chemotherapy. The majority of patients received vancomycin, daptomycin, or gentamicin combined with heparin in a lock solution. Blood culture sterilization was achieved in 69.2% of cases, and sterilization plus CVC retention was achieved in 11 cases (42.3%). Longer durations of ALT (≥9 days) were significantly correlated with blood culture sterilization (odds ratio = 1.367, P = 0.077).ConclusionALT used as an adjunct to systemic therapy for adequate duration in CRBSI can achieve CVC sterilization and retainment without subsequent infectious complications.

The objective of this study is to compare the efficacy and safety of sitagliptin and saxagliptin with placebo and other hypoglycaemic medications in adults with type 2 diabetes. We searched MEDLINE®, Embase, the Cochrane Library and the International Pharmaceuticals from their inception through 3 February 2011. Studies were included of adults with type 2 diabetes that were 12 weeks or more in duration. Meta-analyses were conducted when included studies were homogenous enough to justify combining their results. A total of 32 articles met inclusion criteria. Sitagliptin 100 mg monotherapy and saxagliptin 5 mg resulted in greater HbA1c reduction compared to placebo [weighted mean difference (WMD) -0.82%, 95% CI -0.95 to -0.70 and WMD -0.70, 95% CI -0.84 to -0.56, respectively]. Sitagliptin was similar to sulfonylureas for HbA1c reduction (WMD 0.08%, 95% CI 0-0.16, 3 trials) and to saxagliptin in one head-to-head trial. There was no statistically significant difference in hypoglycaemia between sitagliptin (pooled RR 1.55, 95% CI 0.55-4.36) or saxagliptin (pooled RR 1.04, 95% CI 0.28-3.81) and placebo. Sitagliptin and saxagliptin result in similar modest HbA1c reductions and do not increase the risk of hypoglycaemia unless combined with other therapies. Their role in the long-term treatment of type 2 diabetes remains unclear given the lack of long-term data on efficacy, harms and health outcomes.

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C: Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin 25:2903-2913, 2009 SUMMARY Design. A comprehensive systematic review and meta-analysis. Objective. To assess the effect of self-monitoring of blood glucose (SMBG) on A1C in non-insulintreated patients with type 2 diabetes. Subjects. The analysis included 3,270 non-insulin-treated patients with type 2 diabetes in Canada, the United States, Europe, and Asia. In the 15 studies included, mean age ranged from 50 to 67 years, with 38-74% female patients. Mean duration of diabetes ranged from 0 to 12.5 years. Mean BMI ranged from 27.1 to 34.2 kg/m 2 , and baseline A1C ranged from 6.7 to 11.9%. Methods. Studies included randomized, controlled trials of non-insulin-treated type 2 diabetic patients comparing treatment strategies including SMBG to less frequent or no SMBG. To be included, trials also had to report data on A1C. Two independent reviewers assessed study quality, with any discrepancies resolved by a third reviewer. The authors used heterogeneity statistics (I 2) to determine the appropriate model for analysis, with high