SGLT2 inhibitors are novel diabetes drugs with a wide variety of effects. In this mini-review, a case is presented and the multifaceted effects of SGLT2 inhibitors are discussed in the literature, including my findings on blood-urine electrolyte dynamics and blood gas analysis. The case is a 38-year-old male. He was diagnosed with hypertension and obesity during a routine medical checkup at his company and visited our internal medicine department. After close examination, he was found to have diabetes mellitus, obesity, hypertension, hyperuricemia, abnormal liver function, and sleep-apnea syndrome. After about 6 months, most of the above conditions were under control: weight decreased, blood pressure decreased, the HbA1c level and liver function abnormalities improved, LDL-cholesterol level tended to decrease, and uric acid level decreased. Creatinine levels remained unchanged. Serum electrolytes showed an increase in chloride, but no consistent trend in sodium and potassium. Plasma renin activity increased initially and decreased thereafter. Plasma aldosterone levels decreased. The sympathetic nervous system was not activated. Future studies are required to further elucidate the mechanism of action of SGLT2 inhibitors in various pathological conditions.

In recent years, there has been a nationwide movement to provide patient laboratory data on the out-of-hospital prescription. As Kyokuyaku Midorigaoka Pharmacy routinely receives these prescriptions, we examined whether our prescription inquiries based on laboratory data changed after the printing of laboratory data on prescriptions. In this study, we evaluated a total of 356 prescription inquiries over the six years from 2015 to 2020, before and after the printing of laboratory data. The ratio of inquiries based on laboratory data after the printing was 36.5 times higher compared to that of inquiries before the printing. We investigated whether our inquiries could improve the patients’ laboratory data through prescription change. As a result, the laboratory data, eGFR, which indicates renal function, and high potassium were significantly improved in the group of patients whose prescription was changed by the pharmacist’s inquiry (P = 0.016 and 0.0025, respectively). Furthermore, when investigating the inquiries related to only drugs which cause kidney injury, improvement of patient eGFR was significantly higher in the group of patients whose prescription was changed by the pharmacist’s inquiry than that in the group whose prescription was not changed (P = 0.025). These results suggest that inquiries by pharmacists have led to improved patient outcomes at least with regard to renal function. To our knowledge, the present study is the first in Japan to demonstrate the usefulness of community pharmacists’ inquiries for patient outcomes.

The number of patients with heart failure has been steadily increasing in Japan, resembling somewhat of a heart failure pandemic. Since the failure of patient-related factors rather than medical factors results in the exacerbation of heart failure, heart failure education such as preclinical preventive measures and self-care support is important for the patients. This indicates that there is a need to establish a framework for comprehensive heart failure education that involves multidisciplinary teams available for outpatients and those in a home-care setting, in addition to the heart failure teams in hospitals. Therefore, we conducted a questionnaire survey to ascertain the current statuses and future issues concerning heart failure education in community pharmacies. We obtained responses from 444 local community pharmacies in Hokkaido. More than 85％ of community pharmacists understood the exacerbating factors for heart failure. The pharmacists significantly recognize that heart failure education is a better intervention approach for patients in a home-care setting compared to outpatients. However, only 28.4％ of the pharmacies currently performed interventions against heart failure exacerbation even for the patients in a home-care setting, suggesting that the pharmacies found it difficult to provide prescription proposals and self-care support due to the lack of clinical information and medical cooperation with the medical institutions. Recently, certified heart failure educators have been established and this would potentially attract the attention of the pharmacies. Therefore, it would be desirable to develop professional heart failure educators and implement multifaceted healthcare with multidisciplinary heart failure teams in local communities.

In recent years, the approval of high-priced drugs has increased, and the workload of drug management tasks, such as inventory and temperature controls, has also been increasing. In May 2020, our hospital introduced a pharmaceutical traceability system (Cubixx^® by Suzuken Co., Ltd.). This study aimed to clarify the economic effect of the Cubixx system and changes in workload. The study period was from June 2020 to March 2021. During the study period, 18 drugs with a total cost of approximately 31 million yen were under the management of Cubixx, and drugs with a cost of approximately 300 million yen had been delivered from Cubixx. The amount of drugs returned after delivery was approximately 22 million yen, and the returned drugs were subsequently delivered on a priority basis. The amount of returned and exchanged drugs to pharmaceutical wholesalers was approximately 24 million yen. After the introduction of Cubixx, although the time required to prepare drugs for dispensing was slightly extended, the time required for ordering was reduced to 0 minutes and the number of extraordinary orders became 0 due to the automatic ordering function. In addition, the time required for inventory was also reduced by using the Cubixx portal site. The introduction of Cubixx was suggested to have an economic benefit by avoiding the risk of expiration of immovable drugs. Overall, the introduction of Cubixx was possible without increasing the workload of medical staff.