Pharmacists as the Glue in Cardio-Kidney-Metabolic Care

At the New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum in Boston, Massachusetts, Katelyn O'Brien, PharmD, BCPS, CDCES, BC-ADM, clinical pharmacy specialist in endocrinology at Boston Medical Center, explained to Pharmacy Times how a shared understanding of cardio-kidney-metabolic (CKM) syndrome should reshape early risk stratification and how pharmacists can counteract the clinical inertia that delays sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy.

O'Brien framed CKM syndrome as a set of co-occurring conditions—spanning lipids, obesity, and diabetes—that overlap across the many settings pharmacists work in, including primary care and specialty clinics such as endocrinology, nephrology, cardiology, and hepatology. She described the pharmacist as the "glue" or unifying team member who ensures patients are on the right medications for their risk conditions and who communicates across multi-specialty clinics to support team-based care.

Regarding clinical inertia, O'Brien said barriers operate on multiple levers. From the patient side, they include the burden of another medication, cost, and side-effect concerns. But she identified the primary driver as prescriber-side factors: bias, lack of knowledge, uncertainty about coverage and prior authorizations, and limited visit time—which can push initiation off repeatedly until years pass before a medication is started.

She emphasized that SGLT2 inhibitor benefits can appear relatively quickly depending on the indication, with reductions in heart failure exacerbations and cardiovascular events and slowed kidney disease progression possible within months. To prevent delays, she said, pharmacists can identify access and coverage issues, connect patients to assistance programs when cost is a barrier, and help patients get and stay on therapy—including dose adjustments or non-pharmacological strategies to manage side effects.