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Brian K Irons,1 Molly G Minze21Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Lubbock, 2Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, TX, USAAbstract: Metformin is considered an initial drug of choice for type 2 diabetes mellitus by leading recommendations. When contraindications to its use exist or patients cannot tolerate it due to adverse effects, clinicians have a variety of other classes of agents to treat hyperglycemia associated with type 2 diabetes mellitus. Each class of agent has its own benefit and safety profile. There are numerous factors to consider when selecting another agent in lieu of metformin including, but not limited to, overall efficacy in A1c reduction, adverse effect profile, cost, and patient preference. The number of factors influencing the decision process presents challenges and often no one specific agent is ideal. Each pharmacotherapeutic class of agents alternative to metformin for the treatment of hyperglycemia in type 2 diabetes mellitus as initial monotherapy is reviewed.Keywords: type 2 diabetes mellitus, metformin, monotherapy, hyperglycemia, pharmacotherapy

Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy. Objective: The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population. Methods: A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59) to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg) in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58) in the same clinical setting. Results: The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077) and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153) were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013) but a higher frequency of clinic visits (10.7 versus 3.45, p

Objetivo: Comprender el papel del exenatide en el tratamiento de la diabetes tipo 2, analizando su coste-efectividad comparado con insulina intermedia (NPH) y de larga duración (glargina). Exetanide es una medicación recientemente aprobada para el tratamiento del a diabetes tipo 2, para ser usada además de los antidiabétios orales frecuentemente usados. Métodos: Para evaluar apropiadamente el coste-efectividad de las insulinas comparadas con exenatide, tanto en control glucémico como de peso, se identificaron dos estudios en una búsqueda en Medline (1996 a octubre 2005) que eran similares en duración, control de la glucemia basal, tamaño de la población y resultados principales. Resultados: Tanto la NPH como la glergina parecen ser más coste-efectivos que el exenatide en relación al control glucémico (ratio CE incremental -1968 y -65520 respectivamente). El exenatide parece ser más coste-efectivo para la reducción del peso corporal que la NPH (Ratio CE 235) o la gargina (ratio CE 128). Conclusiones: Comparada con la insulina intermedia y de larga duración, exenatide no parece ser más coste-efectivo para el tratamiento de la diabetes tipo 2. Objective: To better understand exenatide’s role in the treatment of type 2 diabetes, this analysis assessed its cost-effectiveness in comparison to an intermediate (NPH) and long-acting insulin (glargine). Exenatide is a recently approved medication for the treatment of type 2 diabetes for use in addition to frequently used oral diabetes medications. Methods: Two studies were identified by a Medline search (1996-Oct 2005) that were similar in study duration, baseline glycemic control, population size, and primary outcomes to appropriately assess the cost-effectiveness of either insulin in comparison to exenatide on both glycemic and weight control. Results: Both NPH and glargine appear to be more cost effective than exenatide with respect to glycemic control (incremental CE ratios -1,968 and -65,520 respectively). Exenatide appears to be more cost effective for reductions in body weight than either NPH (CE ratio 235) or glargine (CE ratio 128). Conclusions Compared to intermediate and long-acting insulin therapies, exenatide does not appear to be as cost effective for the treatment of type 2 diabetes.