Although the ADA Standards of Care is a living document throughout the year, annually in Dec/Jan they release a large update. For the purposes of this edition of Pharm Aid, I have highlighted the updates that are pertinent to primary care practice in the table below. These Standards continue to be collaborative, with new endorsements this year to 2 sections:
Find the Full Standards of Care here: https://professional.diabetes.org/standards-of-care
This site includes the full standards in PDF and other useful tools:
Despite recent changes made by the Centers for Disease Control and Prevention (CDC) to the childhood immunization schedule, the Wisconsin Department of Health Services (DHS) will not adopt them and will instead continue to follow evidenced-based recommendations from the American Academy of Pediatrics (AAP).
In a statement issued January 8, 2026, DHS representatives mention that the CDC changes were based on brief reviews of other country’s practices, do not appear to be related to new scientific evidence suggesting a need for changes, and do not consider direct evidence regarding risks specific to children in the United States. Wisconsin’s decision aligns with AAP and other prominent medical organizations. To view the recommended vaccines for Wisconsinites, DHS has provided a link to the schedules via their website.
Changes to the CDC Childhood Immunization Schedule has resulted in the elimination of recommended vaccines against COVID-19, hepatitis A/B, influenza, meningococcal, rotavirus, and RSV. The decision to receive these vaccines should instead now be based on whether one falls within defined high-risk risk groups and/or through shared decision making.
As a result of DHS’s decision, Wisconsin Medicaid will continue to provide reimbursement for all recommended vaccines for Medicaid members (newborns included). In addition, recommended vaccines will continue to be available through the Vaccines for Children program.
An interesting study appearing in the journal Physics of Fluids suggests that body position may significantly alter drug dissolution and absorption rates.
The study, funded by the National Science Foundation and National Institutes of Health, in partnership with the Johns Hopkins University departments of medicine, mechanical engineering, computational medicine, and gastroenterology and hepatology, was published in 2022.
Prior to the study, the gold standard for measuring and assessing drug bioavailability included the U.S. Pharmacopeia (USP) dissolution apparatus and various pharmacokinetic/pharmacodynamic (PK/PD) analyses. While these methods are robust, they are unable to account for key factors affecting the bioavailability of drugs, including posture and gastric motility.
For this study, researchers used computational fluid dynamics, widely used in the study and development of medical devices like ventricular assist devices, prosthetic heart valves and blood filters, to create models of gastrointestinal tract biomechanics and digestive processes to investigate the effect of posture and gastroparesis when meds are taken orally.
Four body positions were evaluated:
The results were notable. Body position resulted in up to an 83% difference in gastric emptying into the duodenum, where most medications are absorbed. The right lateral supine position resulted in the fastest dissolution and release of gastric contents into the duodenum. This makes logical sense, as this is the position where the direction of gravity aligns with the antrum and pylorus.
Conversely, lying on the left side resulted in the slowest delivery of gastric contents to the duodenum. While it makes sense that gravity would cause gastric contents to pool in the antrum with left side positioning, it took 5 times longer for a medication to reach the small intestine in the left lateral supine position than an upright position.
Furthermore, the researchers found that various postures can potentially reduce bioavailability to an extent similar to that of severe gastroparesis. This may have significant implications for drug absorption in patients confined to bed or those spending a significant amount of time lying down.
While the results of this study are primarily hypothesis-generating at this point, they may prove helpful for patients. While it is always recommend to swallow oral medications with a full glass of water to facilitate drug delivery to the stomach and drug dissolution once it reaches the stomach, if faster results are needed (analgesics or oral headache medications, for example), consider recommending patients lie down on their right side after swallowing the medication for optimal results, or remaining upright if lying down is uncomfortable or otherwise impractical for the patient.
Clinical Pharmacy Practitioner in Primary Care
Mike Grunske, PharmD, BCPS
Mike Grunske is a Board-Certified Pharmacotherapy Specialist (BCPS). Mike transitioned his practice to the Clement Zablocki VA Medical Center where he has since practiced in the Primary Care Clinics as a Clinical Pharmacist Practioner. Within this role, his practice involves direct care and management of patients’ medication regimens. He has worked as an active preceptor for both pharmacy students and residents throughout his entire career. Mike is also Past-President and former Foundation Chair of the Pharmacy Society of Wisconsin (PSW).
Mike is married to a fellow PharmAid contributor (Vanessa Grunske). Together they have a teenage daughter and son. He enjoys traveling with his family, attending his kid’s cheer, baseball, and basketball events, and spending any available leftover time running and hunting.
Pharmacist at Advocate Aurora Health
Vanessa Grunske, PharmD, BCACP
Vanessa practices with Advocate Aurora Health in Milwaukee, where she sees patients at Aurora Sinai Medication Management Clinic and maintains a dispensing practice at St. Luke’s Medical Center. Board-certified in ambulatory care pharmacotherapy, her practice interests include diabetes, hypertension, smoking cessation, geriatrics, improving health literacy, and medication adherence. She particularly enjoys and spends a good share of her work hours teaching and mentoring pharmacy students, family medicine residents and pharmacy residents.
She and her husband, Mike, live in the Milwaukee area with their two teenage children. In her free time, she enjoys cooking, baking, visiting our national parks with her family or relaxing on a beautiful Caribbean beach.
Professor at Concordia University Wisconsin School of Pharmacy
Beth Buckley, PharmD, CDCES
Beth Buckley, PharmD, CDCES (Certified Diabetes Care and Education Specialist), is a Professor of Pharmacy Practice at the Concordia University Wisconsin School of Pharmacy, where she has a teaching role within all years of the curriculum with a focus on Applied Patient Care Skills Lab, Diabetes Pharmacotherapy, and electives in the areas of diabetes and wellness. Her current role is ambulatory care pharmacist where she works with a Collaborative Practice Agreement to provide chronic disease state management within a primary care clinic.
When not working, she enjoys reading, gardening, traveling with her husband, volunteering within the community, and active fun: hiking, biking, dog walking, practicing yoga, mindfulness, and living with intention and gratitude.
Disclaimer: The Wisconsin Academy of Family Physicians (WAFP) has entered into a business relationship with Pharm Aid to offer our members discounts and exclusive savings. This or other affinity program relationships presented by the WAFP in no way implies a WAFP endorsement of the program, supplier, or vendor.
