The prevalence and associated clinical burden of type 2 diabetes (T2D) is increasing in the USA and other countries. As a consequence, the role of the pharmacist in managing T2D is expanding, and it is becoming increasingly important for pharmacists to have a complete understanding of the disease course and treatment options. Pharmacists have a key role in the use of injectable therapies, including incretin-based treatment with glucagon-like peptide-1 receptor agonists (GLP-1RAs). This article discusses the role of the pharmacist in the management of patients with T2D, particularly with respect to the use of GLP-1RAs to achieve glycemic control. GLP-1RAs are a class of injectable agents used as an adjunct to diet and exercise to improve glycemic control in adults with T2D. GLP-1RAs have been shown to lower glucose levels, slow gastric emptying, enhance satiety, and reduce body weight without increasing the risk of hypoglycemia. GLP-1RAs currently approved in the USA include exenatide twice daily, liraglutide once daily, and albiglutide, dulaglutide, and exenatide once weekly. Pharmacists can work with physicians to help identify patients for whom GLP-1RA therapy is appropriate. In addition, pharmacists can educate patients regarding medication storage, preparation, and injection techniques, glycated hemoglobin (HbA1c) targets, pre- and post-meal blood glucose goals, adverse events and management strategies, and the long-term benefits of reducing HbA1c. As members of the diabetes care team, pharmacists play an important role in improving patient outcomes.
Centers for Disease Control and Prevention (CDC). National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services. 2014. http://www.cdcgov/diabetes/pubs/statsreport14/national-diabetes-report-webpdf. Accessed 17 Nov 2016.
Campbell RK. Role of the pharmacist in diabetes management. Am J Health Syst Pharm. 2002;59(Suppl 9):S18–21. PubMed
American Diabetes Association. 6. Glycemic targets. Diabetes Care. 2015;38(Suppl):S33–40. CrossRef
Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79. CrossRefPubMedPubMedCentral
Wong ND, Patao C, Wong K, Malik S, Franklin SS, Iloeje U. Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: comparison by prevalent cardiovascular disease status. Diabetes Vasc Dis Res. 2013;10:505–13. CrossRef
Pharmacy Times. Advances in injection technique: impact on adherence in patients with diabetes. http://www.pharmacytimescom/publications/issue/2012/october2012/r566_12oct_diabetes. Accessed 9 Jan 2017.
American Association of Diabetes Educators. The injection impact report fact sheet. 2008. http://www.injectionimpact.com/surveyresults.html. Accessed 9 Jan 2017.
Tonarelli L. Managing diabetes: the role of pharmacists. Diabetes advice. Media Planet. 2014. http://www.diabetesadvice.co.uk/care-and-medication/managing-diabetes-the-role-of-pharmacists. Accessed 9 Jan 2017.
Blenkinsopp A, Gray A, Picton C, et al. Hospital referral to community pharmacy: an innovators’ toolkit to support the NHS in England. 2014. http://www.rpharms.com/support-pdfs/3649---rps---hospital-toolkit-brochure-web.pdf. Accessed 9 Jan 2017.
Byetta ® (exenatide): US prescribing information. Wilmington: AstraZeneca; 2015.
Victoza ® (liraglutide): US prescribing information. Plainsboro: Novo Nordisk Inc.; 2015.
Marre M, Shaw J, Brandle M, et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabet Med. 2009;26:268–78. CrossRefPubMedPubMedCentral
Bydureon ® (exenatide extended release): US prescribing information. Wilmington: AstraZeneca; 2015.
Russell-Jones D, Cuddihy RM, Hanefeld M, et al. Efficacy and safety of exenatide once weekly versus metformin, pioglitazone, and sitagliptin used as monotherapy in drug-naive patients with type 2 diabetes (DURATION-4): a 26-week double-blind study. Diabetes Care. 2012;35:252–8. CrossRefPubMedPubMedCentral
Frías JP, Guja C, Hardy E, et al. Exenatide once weekly plus dapagliflozin once daily versus exenatide or dapagliflozin alone in patients with type 2 diabetes inadequately controlled with metformin monotherapy (DURATION-8): a 28 week, multicentre, double-blind, phase 3, randomised controlled trial. Lancet Diabetes Endocrinol. 2016;4:1004–16. CrossRefPubMed
Tanzeum ® (albiglutide): US prescribing information. Wilmington: GlaxoSmithKline; 2015.
Nauck MA, Stewart MW, Perkins C, et al. Efficacy and safety of once-weekly GLP-1 receptor agonist albiglutide (HARMONY 2): 52 week primary endpoint results from a randomised, placebo-controlled trial in patients with type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetologia. 2015;59:266–74. CrossRefPubMedPubMedCentral
Reusch J, Stewart MW, Perkins CM, et al. Efficacy and safety of once-weekly glucagon-like peptide 1 receptor agonist albiglutide (HARMONY 1 trial): 52-week primary endpoint results from a randomized, double-blind, placebo-controlled trial in patients with type 2 diabetes mellitus not controlled on pioglitazone, with or without metformin. Diabetes Obes Metab. 2014;16:1257–64. CrossRefPubMed
Ahren B, Johnson SL, Stewart M, et al. HARMONY 3: 104-week randomized, double-blind, placebo- and active-controlled trial assessing the efficacy and safety of albiglutide compared with placebo, sitagliptin, and glimepiride in patients with type 2 diabetes taking metformin. Diabetes Care. 2014;37:2141–8. CrossRefPubMed
Rosenstock J, Fonseca VA, Gross JL, et al. Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro. Diabetes Care. 2014;37:2317–25. CrossRefPubMed
Pratley RE, Nauck MA, Barnett AH, et al. Once-weekly albiglutide versus once-daily liraglutide in patients with type 2 diabetes inadequately controlled on oral drugs (HARMONY 7): a randomised, open-label, multicentre, non-inferiority phase 3 study. Lancet Diabetes Endocrinol. 2014;2:289–97. CrossRefPubMed
Trulicity ® (dulaglutide): US prescribing information. Indianapolis: Eli Lilly and Company; 2015.
American Diabetes Association. 8. Cardiovascular disease and risk management. Diabetes Care. 2015;38(Suppl):S49–57. CrossRef
Best JH, Hoogwerf BJ, Herman WH, et al. Risk of cardiovascular disease events in patients with type 2 diabetes prescribed the glucagon-like peptide 1 (GLP-1) receptor agonist exenatide twice daily or other glucose-lowering therapies: a retrospective analysis of the LifeLink database. Diabetes Care. 2011;34:90–5. CrossRefPubMed
GlaxoSmithKline. A long term, randomised, double blind, placebo-controlled study to determine the effect of albiglutide, when added to standard blood glucose lowering therapies, on major cardiovascular events in patients with type 2 diabetes mellitus (HARMONY Outcomes). https://clinicaltrials.gov/ct2/show/NCT02465515. Accessed 17 Nov 2016.
Eli Lilly and Company. The effect of dulaglutide on major cardiovascular events in patients with type 2 diabetes: researching cardiovascular events with a weekly incretin in diabetes (REWIND). https://clinicaltrials.gov/ct2/show/NCT01394952. Accessed 17 Nov 2016.
Buse JB, Garber A, Rosenstock J, et al. Liraglutide treatment is associated with a low frequency and magnitude of antibody formation with no apparent impact on glycemic response or increased frequency of adverse events: results from the liraglutide effect and action in diabetes (LEAD) trials. J Clin Endocrinol Metab. 2011;96:1695–702. CrossRefPubMed
Johnson S, Nauck MA, Zhi H, Weston C, Russo C, Holland C. Integrated phase 3 immunogenicity results for albiglutide. Diabetes. 2014;63(Suppl 1):A427.
Milicevic Z, Anglin G, Harper K, et al. Low incidence of anti-drug antibody in type 2 diabetes patients treated with once-weekly dulaglutide. Diabetes. 2015;64(Suppl 1):A292.