Question for the clinic: My patients have been on a roller-coaster of weight loss/weight gain due to sporadic shortages of the GLP1-RA drugs. Is there something I can do to decrease the amount of weight gain in between?
Answer: Try teaching your patients to use Mindful Eating as a strategy: Before starting or while taking the GLP1-RA, practicing mindful eating can help people to learn more about their own satiety signals, with observation of the portions and food choices that help them successfully lose weight. When they stop the GLP1-RA, they can continue to use these strategies for sustainable weight reduction.
Evidence: A systematic review and meta-analysis of randomized controlled trials for mindful eating or intuitive eating for weight loss concluded that mindful/intuitive eating shows a significant weight loss vs nonintervention, comparative to other dietary strategies for weight loss, and could be a practical approach to weight control. Many interventional and observational studies have shown this strategy to improve eating behaviors such as food choice, intake of less food, reduction of binge eating/emotional eating, and decreased intake of sweets in populations with diabetes.
What it is: Mindfulness is "The awareness that emerges through paring attention on purpose, in the present moment, and non-judgmentally." — Jon Kabat Zinn
Mindful eating includes self-monitoring and awareness from focused attention to hunger and satiety cues while eating, without judgement. It innvolves paying close attention to our food choices and their effect on our emotions by using our physical and emotional senses to experience the food. The foundation comes from intuitive eating, which trains the body to intrinsically know the the quantity and components of food required for an individual to maintain nutritional health and a healthy body weight (AKA body wisdom").
How to eat mindfully:
References
Fung TT, Long MW, Hung P, Cheung LW. An expanded model for mindful eating for health promotion and sustainability: issues and challenges for dietetics practice. Journal of the Academy of Nutrition and Dietetics. 2016 Jul 1;116(7):1081-6.
Harvard T.H.Chan School of Public Health. Mindful Eating:
Miller CK, Kristeller JL, Headings A, Nagaraja H. Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a randomized controlled trial. Health Education & Behavior. 2014 Apr;41(2):145-54.
https://greatergood.berkeley.edu/article/item/how_to_eat_mindfully_by_listening_to_your_body
An anticipated shortage of tetanus and diphtheria (Td) vaccines has led the Centers for Disease Control and Prevention (CDC) to issue guidance to help providers navigate therapy decisions as a result. Up until recently, two pharmaceutical manufacturers produced Td vaccines that have been available in the United States:
MassBiologics has since made the decision to stop production of this vaccine. As a result of this, Sanofi has initiated steps to increase production and availability of their Td vaccine. It is anticipated that it will take some time for these steps to take effect and a shortage of the vaccine is expected at least through the remainder of 2024. This shortage currently does not impact the supply of diphtheria, tetanus, and acellular pertussis (Tdap) vaccines. The CDC has issued guidance for how providers should approach this shortage if Td vaccine is not available. A summary of the CDC’s guidance includes:
At this time, there are no specific projections as to how long this Td vaccine shortage will last while Sanofi works to increase their production. The above recommendations should be followed in the interim.
To read the CDC’s Advisory Committee on Immunization Practices (ACIP) full recommendation for the overall use of DTaP/Tdap/Td, as well as guidance for use during this anticipated shortage, click here.
The Centers for Disease Control and Prevention (CDC) recently published guidance for medical providers regarding the use of doxycycline when used for postexposure prophylaxis against sexually transmitted infections (STI) in certain populations. The report specifies that doxycycline postexposure prophylaxis (doxy PEP) can be used in men who have sex with men (MSM) and transgender women (TGW) who have had a bacterial STI (ex. syphilis, chlamydia, or gonorrhea) in the past 12 months. Specifically, the recommendation states that doxy PEP 200mg (given as one dose) should be administered within 72 hours after having oral, vaginal, or anal sex. The CDC’s recommendation suggests that doxy PEP should be provided in advance of potential exposures, and that enough doses be provided to the patient based on their anticipated sexual activity in between follow-up visits.
The CDC further goes on to highlight that if doxy PEP is provided, it should be only one part of a thorough sexual health review with the patient. Discussion should also take place regarding risk reduction, regular STI screening (as appropriate at time of exposure and every 3-6 months thereafter), as well as a review of recommended vaccinations based on risk factors. These recommendations are in addition to the recommended HIV screening already in place.
At this time, the recommendation applies specifically to the MSM and TGW patient populations. Clinical data supporting the use of doxy PEP in other populations (ex. cisgender women, cisgender heterosexual men, transgender men, and other queer and nonbinary persons assigned female at birth) is currently limited, and therefore not part of this guideline. As a result, the CDC suggests that providers use clinical judgment and shared decision-making with patients who are of these other groups as to whether doxy PEP may also be appropriate for them.
Although there are risks when using antibiotics for prophylactic use (ex. antibiotic resistance, medication adverse effects), the CDC feels the benefits outweigh the risks. They note the increasing rates of bacterial STIs being seen across the population as well as the high efficacy rates noted with doxy PEP use as factors in their decision.
Reference:
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.
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