ADA Standards of Care: Beyond the Classroom

Applying what’s learned in the classroom to real-world patient care can be a daunting but rewarding experience. As an incoming third-year PharmD student, I recently had the opportunity to do just that. I have worked at a statewide pharmacy chain for the past 4.5 years, and one aspect of my work that I particularly enjoy is finding ways to apply what I learn in the classroom to my practice. After learning about diabetes pharmacotherapy, I found myself wondering if our patients were receiving evidence-based care.

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the treatment of type 2 diabetes has become increasingly prevalent in recent years. This presents an opportunity for pharmacists and pharmacy interns to identify patients receiving overlapping incretin-based therapies and make recommendations for medication optimization.¹

One example of potentially duplicative incretin-based therapies is the concurrent use of dipeptidyl peptidase-4 (DPP-4) inhibitors with GLP-1 RAs. According to the 2026 American Diabetes Association (ADA) Standards of Care, concurrent use of DPP-4 inhibitors with GLP-1 RAs is not recommended because it does not provide additional glucose-lowering benefit compared to GLP-1–based therapy alone.² Additionally, discontinuing an unnecessary medication can reduce pill burden and potentially decrease out-of-pocket costs. Rather than letting this information remain something I only learned for an exam, I wanted to determine whether it was relevant to the patients I served.

To do this, I generated a list of patients who were currently taking a DPP-4 inhibitor and reviewed each individual profile to see if they were also receiving a GLP-1 RA. I identified 7 patients receiving this potentially duplicative incretin therapy. After reviewing each patient’s medication regimen, I contacted the prescribers, explained the rationale for the recommendation, and recommended discontinuing the DPP-4 inhibitor when appropriate while continuing the GLP-1 based therapy.

During this process, I learned that some prescribers preferred receiving therapeutic recommendations by fax rather than by telephone. This presented a new challenge: our pharmacy did not have a standardized form for communicating these recommendations. So, I decided to create one.

I developed a form containing the patient and medication information, the identified therapeutic issue, clinical rationale, supporting guideline reference, recommendation, and a section for the prescriber to respond. I shared the initial version with my pharmacist, who helped refine the form and provided valuable feedback.

One of the recommendations I faxed using the new form involved a patient receiving sitagliptin (Januvia; Merck) concurrently with semaglutide (Ozempic; Novo Nordisk). After reviewing the recommendation, the prescriber completed and returned the form, agreeing with the intervention and discontinuing the sitagliptin. I subsequently spoke with the patient to explain the change in therapy, and they were pleased to see a medication being removed rather than added. Seeing the recommendation progress from identifying a potential medication therapy problem, to reviewing evidence, to communicating with the prescriber, and ultimately to a change in the patient’s medication regimen was especially meaningful to me. It demonstrated how knowledge gained in the classroom can translate into practical intervention and medication optimization.

I initially shared the form with my pharmacy leadership team hoping to receive feedback and suggestions for improvement, but what I received was much more. Our company’s Director of Pharmacy Operations took an interest in the project and recognized that this form could benefit all our pharmacies. He subsequently shared the form across the entire company, making it available to all pharmacists throughout the organization.

Looking to the future, I hope this resource can evolve from a paper-based form that must be filled out and faxed manually, to being integrated into our pharmacy management system. Ideally, pharmacists could identify the therapy concern, generate the recommendation within the system, and fax it directly to the prescriber. This kind of integration could make the process more efficient and help facilitate pharmacist-initiated medication optimization.

This experience reinforced the importance of looking for opportunities to apply what we learn in the classroom to everyday pharmacy practice. What began as a question about duplicative therapy ultimately led to a patient-specific intervention, the development of a tool for communicating recommendations, and a resource now available to pharmacists all throughout my community. As I continue my education and future career in pharmacy, I hope that I, along with my fellow student pharmacists, continue to look beyond the classroom and identify opportunities to improve patient care and turn what is learned into meaningful action.

About the Author

Ethan Barnhart is a 2028 PharmD candidate at Northeast Ohio Medical University and a student pharmacist at Discount Drug Mart.

REFERENCES

1. Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context. 2015;4:212283. doi:10.7573/dic.212283

2. American Diabetes Association Professional Practice Committee for Diabetes. Pharmacologic approaches to glycemic treatment: standards of care in diabetes—2026. Diabetes Care. 2026;49(Suppl_1):183-215. doi:10.2337/dc26-S009