David Cabral, 2017 PharmD Candidate, the University of Connecticut

 in long-term care senior patients is not an easy task. Polypharmacy, kidney disease, and irregular meals make oral antidiabetic mediations a less-than-ideal option. For this reason, long-term care facilities often use sliding-scale insulin (SSI). A recent retrospective analysis showed that nearly 75% of long-term care patients with diabetes received SSI.

An article published in the February 2017 issue of 

 reviewed SSI use in long-term care, highlighted its drawbacks, and explored alternatives.

SSI regimens involve finger-stick blood glucose testing followed by short-acting insulin administration. The insulin dose is variable based on the blood glucose reading. 

However, SSI therapy use has risks, and the American Diabetes Association (ADA) currently recommends against SSI use. Aside from frequent finger sticks, SSI has shown poorer glucose control and a higher burden of care.

The Centers for Medicare and Medicaid Services (CMS) created an assessment tool to evaluate adverse event risk in nursing facility practices. The tool specifically identifies SSI use as a risk factor for hypoglycemia. The CMS recommends strict documentation of insulin administration and monitoring of signs/symptoms and food consumption as prevention techniques.

The American Medical Directors Association (AMDA) also published recent guidelines that advise against routine use of SSI. The authors recommend using this information to educate staff and create regulated diabetes care protocols for safe insulin use.

Basal-bolus insulin (B-BI) is mentioned as an alternative option to SSI. With B-BI therapy, patients receive a long-acting basal insulin for 24-hour coverage along with bolus rapid-acting insulin before meals. B-BI mimics physiological insulin release and has been shown to significantly decrease fasting blood glucose levels compared to SSI.

SSI therapy is commonly used in long-term care facilities despite strong counter-evidence from the ADA, AMDA, CMS, and other diabetes care experts. Providers at these facilities must consider the evidence and adjust current guidelines to meet their patient’s needs.

Bear MD, Bartlett D, Evans P. Pharmacist counseling and the use of nonsteroidal anti-inflammatory drugs by older adults. 

Articles

A recent retrospective analysis showed that nearly 75% of long-term care patients with diabetes received SSI.

Sliding-Scale Insulin: Time to Say Goodbye?

With more than 300 million users, Instagram is one of the most popular social media platforms available. The image-sharing interface has allowed subscribers to share information and ideas with others around the globe. Users on Instagram post photos and videos from their daily lives, linking them to searchable data tags called hashtags (denoted with a preceding # symbol).

Journal of the American Pharmacists Association

 analyzed the use of the “#pharmacist” tag on Instagram. The researchers hoped to categorize the intent of the collected posts and discern whether they were self-portrayed or health care related images.

After a 14-day trial period, the researchers selected 661 posts that used #pharmacist in their caption. The posts were characterized into categories including 

 and more. Investigators then subjectively determined if the posts contained self-portrayed images and if they were related to health care.

 contained 12.6%. All other categories contained 10% or less of the Instagram posts. 

Less than a fourth (23.2%) of the posts were self-portrayed images. Conversely, the vast majority (88%) of posts were related to health care.

Given that only 5.5% of images provided patient education or drug information and just 1.8% of images were viewed as advocating for the pharmacy profession, pharmacists may be ignoring a useful mode of communication with prospective patients in this social media-driven age.

The authors also expressed concern for the potential risks social media exposure brings. Since the content is all user-created, false information can easily spread online and damage credibility. They also caution against the use of humor as it may promote negative stereotypes about the profession.

In an ever-changing technological world, Instagram and other forms of social media can be useful tools for pharmacists to provide patient education, public health information, or professional advocacy to diverse patients worldwide.

Hindman FM Jr, Bukowitz AE, Reed BN, Mattingly TJ 2nd. No filter: A characterization of #pharmacist posts on Instagram. 

 (2003). 2017 Mar 4. pii: S1544-3191(17)30009-2. doi: 10.1016/j.japh.2017.01.009. [Epub ahead of print]

A new study published in the Journal of the American Pharmacists Association analyzed the use of the “#pharmacist” tag on Instagram. 

White Coats on Instagram: What Does Pharmacy Look Like?

Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most common and accessible medications available. More than 70 million NSAID prescriptions are written annually in the United States, and approximately 30 billion doses are sold over the counter. 

NSAIDs are included in the Beers criteria list as potentially inappropriate for older patients. Because they are so easily obtained, patients may be unaware of their potentially hazardous side effects, including hypertension, gastrointestinal bleeds, and kidney injury. Older patients are at an increased risk of experiencing these adverse reactions because of their impaired drug metabolism, comorbidities, or low health literacy.

Researchers at MCHPS University published a study in the March 2017 issue of 

that explores the effects of pharmacist counseling on NSAID use.

Pharmacists and pharmacy students interviewed 83 patients aged 60 and older and questioned them on their use of NSAIDs. They also collected information on their demographics and comorbidities. Patients received counseling on NSAID adverse reactions and suggestions for safer drug dosing or alternative therapy.

Of the 39 patients that reported using NSAIDs, 28 patients also used an interacting drug or had an interacting comorbidity. After follow-up, this number of inappropriate users dropped to 19.  Half of the patients reported changing their use of NSAIDs after receiving counseling, and more than 70% stated that they had a better understanding of NSAID risks.

More than half of the follow-up patients reported having a more meaningful conversation with their physician after receiving counseling, and nearly all of them stated they would recommend NSAID counseling to others.

Only 3 patients reported receiving pharmacist counseling on NSAID safety previously, highlighting a potential opportunity for pharmacists to make a significant clinical impact.

The authors concluded that health care providers should identify at-risk patients and provide NSAID education to protect the rapidly growing senior population from negative outcomes.

Woods J. Nadelson M. Sliding-scale insulin use in long-term care: an updated perspective. 

NSAIDs are included in the Beers criteria list as potentially inappropriate for older patients. 