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Background There are more than 350 reports of hyperglycemia post-influenza vaccine according to the Vaccine Adverse Effect Reporting System. Only one case report has been published detailing unusual post-vaccination hyperglycemia. The mechanism as to why hyperglycemia may occur post-vaccination has not been fully elucidated. Objective Primary: To identify hyperglycemia within the first 24 hours of influenza vaccine. Secondary: To identify transient property of hyperglycemia within 4 days after vaccine. Methods Multicenter prospective cohort study. Recruitment conducted throughout San Antonio, Texas, during 2018-2020 influenza seasons. Patients were included if 18 years or older, had diabetes mellitus, and currently checking their blood glucose daily. Patients excluded if they had a recent medication change that would effect their blood glucose readings. Patients had hemoglobin A1c and blood glucose measured prior to vaccination with a single dose (0.5 mL) of the tri-valent influenza vaccine intramuscularly. Glucose readings were collected within 24 hours post-vaccination and subsequent mornings for 4 days. Results A total of 34 patients were included. Average patient age was 75 years with 60% white, 30% black, and 10% Hispanic. Median fasting glucose pre-vaccination was significantly lower than the median value 0 to 24 hours post-vaccination (140 vs 203 mg/dL, P < 0.0001). Conclusion and Relevance Hyperglycemia was noted 0 to 24 hours post-vaccination and was transient in nature with a return to baseline by post-vaccination day 2. This trial was conducted to close a potential gap in counseling regarding the flu vaccine and decrease any potential concern surrounding the vaccine in patients with diabetes that could lead to reduced vaccination rates.

Cannabidiol (CBD) oil has been gaining popularity as a natural alternative for numerous disease states. CBD is a phytocannabinoid obtained from the Cannabis sativa plant. Unlike its relative tetrahydrocannabinol (THC), CBD does not activate CB1 receptors in the brain and therefore lacks psychotropic effects (1). Instead, this substance is thought to work on the G-protein coupled receptor, endothelial cannabinoid receptor, and serotonin-1A receptors, among others. Diabetes is the seventh leading cause of death and affects >30 million people in the United States (2). CBD has been investigated, mostly in animal models, for its ability to help treat diabetes. It is theorized that cannabis has desirable effects on hyperglycemia through its anti-inflammatory and antioxidant properties (3). The endocannabinoid system modulates food intake and energy homeostasis by activating cannabinoid receptors. Modulation of these receptors with CBD has the possibility to reduce body weight and A1C in people with diabetes. In one study using mouse models, CBD was shown to significantly reduce the incidence of diabetes in these mice (4). This was shown by a significant decrease in pancreatic islets production of destructive insulitis and inflammatory cytokine production. The potential to use CBD as a method to treat diabetes reveals the need for studies and case reports. The following case illustrates the initiation of CBD in a patient with type 2 diabetes. A 62-year-old Hispanic obese man (weight 113 kg, BMI 39 kg/m2) with a history of type 2 diabetes for 11 years began taking CBD oil to control his blood glucose in place of insulin degludec. Initiation of this product was independent of his clinician’s recommendation and based on the patient’s personal review of information that suggested CBD was beneficial for people with type 2 diabetes. As shown in Table 1, the week before the patient’s initiation of CBD, …

Diabetes is a complex, chronic medical condition affecting 29.1 million people in the United States (9.3% of the population) and is projected to affect one in three Americans by 2050 if the current trend continues (1). Diabetes management can be challenging, often requiring multiple therapeutic agents as the disease progresses. Current guidelines recommend metformin as first-line pharmacological therapy for the treatment of type 2 diabetes. Multiple second-line options are available for patients whose A1C goal is not achieved with monotherapy, and selection should be based on patient- and drug-specific factors. Sodium–glucose cotransporter 2 (SGLT2) inhibitors, the newest U.S. Food and Drug Administration (FDA)–approved oral antidiabetic agents, are among these options for patients with type 2 diabetes. Canagliflozin, dapagliflozin, and empagliflozin are the currently available SGLT2 inhibitors in the United States (2,3). Sodium–glucose cotransporter 1 (SGLT1) is predominantly located in the small intestine, but is also expressed in the kidneys, trachea, heart, and colon (4,5). In the kidneys, SGLT1 is primarily located in the S3 segment of the proximal convoluted tubule (PCT) (4). SGLT2 is expressed in the kidneys and primarily located in the S1 and S2 segments of the PCT (4,5). In normoglycemic adults, about 180 g of glucose (Figure 1) is filtered per day in the glomerulus, and most is reabsorbed (4,6). In people with diabetes, reabsorption of glucose is increased compared to people without diabetes (7,8). SGLT1 and SGLT2 are located in the apical membrane and facilitate the transport of glucose with sodium from the renal tubular lumen into the cells (Figure 2) (4). FIGURE 1. Structures of glucose, phlorizin, canagliflozin, dapagliflozin, and empagliflozin. FIGURE 2. Cotransport of glucose and sodium by SGLT1 and SGLT2 in the PCT. Phlorizin (Figure 1), an O -glucose derivative/ O -glycoside, was discovered in …

There are 29.1 million people in the United States living with diabetes (1). Except in cases with contraindications, annual influenza vaccination is recommended for all people with diabetes to reduce morbidity, mortality, and health care costs associated with influenza illness (2,3). There were 12 influenza vaccines available for the 2016–2017 influenza season. These vaccines were categorized into inactivated or live, quadrivalent or trivalent, and high-dose or standard-dose formulations (2). Common adverse reactions of pain, soreness, fever, muscle aches, fatigue, redness, or swelling may occur after intramuscular vaccine administration (4). Hyperglycemia is not noted as an adverse reaction in vaccine package inserts; however, reports of its occurrence have been documented in the Vaccine Adverse Event Reporting System (VAERS) (5). Since 1991, there have been 946 reports of hyperglycemia with all available vaccines and 361 reports of hyperglycemia with all types of influenza vaccines. When looking specifically at the trivalent influenza vaccine, there have been 235 reported cases, with 70.6% reported during the first 4 days after vaccine administration (5). In light of these reports, a literature search was performed to obtain more information about acute hyperglycemia after vaccine administration. The search was performed with the advanced search option in PubMed using the terms "hyperglycemia,” “blood sugar,” “blood glucose,” “vaccines,” “influenza vaccine,” “diabetes,” and “immunizations.” The search failed to yield any literature reports specifically related to blood glucose …

IN BRIEF Six million people with diabetes use insulin either alone or in combination with an oral medication. Many barriers exist that lead to poor adherence with insulin. However, there is an underwhelming amount of data on interventions to address these barriers and improve insulin adherence. Until pharmacological advancements create easier, more acceptable insulin regimens, it is imperative to involve patients in shared decision-making.

Objective To determine which skills are essential for pharmacy students in the United States as reported by advanced pharmacy practice experience preceptors. Methods Pharmacy faculty developed a survey used to collect demographic and other information regarding essential skills for pharmacy graduates. Survey responses were evaluated qualitatively and reported quantitatively. Results Communication was identified as an essential skill for pharmacy graduates. Graduates should also be able to prepare sterile and nonsterile compounds, evaluate patient and prescription information as well as vital signs and laboratory values. Graduates should be able to independently identify and solve problems using critical thinking. Appropriate dress and personal hygiene and the ability and willingness to collaborate were also important. Conclusion Pharmacy graduates must be able to communicate. In addition, they should maintain a professional appearance and possess a wide variety of practical pharmacy skills.

Introduction To describe current methods used to assess SOAP notes in colleges and schools of pharmacy. Methods Members of the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group were invited to share assessment tools for SOAP notes. Content of submissions was evaluated to characterize overall qualities and how the tools assessed subjective, objective, assessment, and plan information. Results Thirty-nine assessment tools from 25 schools were evaluated. Twenty-nine (74%) of the tools were rubrics and ten (26%) were checklists. All rubrics included analytic scoring elements, while two (7%) were mixed with holistic and analytic scoring elements. A majority of the rubrics (35%) used a four-item rating scale. Substantial variability existed in how tools evaluated subjective and objective sections. All tools included problem identification in the assessment section. Other assessment items included goals (82%) and rationale (69%). Seventy-seven percent assessed drug therapy; however, only 33% assessed non-drug therapy. Other plan items included education (59%) and follow-up (90%). Discussion and conclusions There is a great deal of variation in the specific elements used to evaluate SOAP notes in colleges and schools of pharmacy. Improved consistency in assessment methods to evaluate SOAP notes may better prepare students to produce standardized documentation when entering practice.

Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.