09 Oct 2024 TI Blog Update: October 2024
In this TI Blog October update we share information about the upcoming TI Best Evidence annual course, an in-person workshop on deprescribing, the latest issue of the Therapeutics Letter, the next webinar in the TI Methods Speaker Series and a preview of webinars we will be offering in November. Enjoy!
First, we are excited that our TI Best Evidence annual course on October 19th returns for the first time since COVID19 to in-person education (plus online, by Zoom). REGISTRATION for this popular annual course is open for a few more days and you can save up to $50 if you register before October 11. Evaluations by past attendees often say they appreciate “the other side of the story” about prescription drugs – presented and discussed by an unconflicted faculty. Please consider joining us for Best Evidence 2024, and let your colleagues or students know about this opportunity. More details below.
Meanwhile, I encourage you to consider attending our October 18th intensive 3.5 hour in-person workshop: Feeling Good About Deprescribing workshop. In very small groups, every participant gets to think through a number of cases of real patients for whom deprescribing should be considered (or is in process). A bargain at the registration fee of $99 for the afternoon, I can also guarantee that you will learn practical skills from your colleagues and from facilitating faculty. Read more about this workshop or REGISTER.
We just released issue 151 (September-October 2024) of the Therapeutics Letter: Minimizing harms of tight glycemic control in older people with type 2 diabetes, together with a prescribing Portrait. Therapeutics Letter 151 focuses on changes in understanding of the clinical importance of “tight control” of blood sugar for people with type 2 diabetes. Says Dr. Wade Thompson, a clinical pharmacist and Assistant Professor in the UBC Department of Anaesthesiology, Pharmacology & Therapeutics and international expert in deprescribing:
“In the last 10 years, it has become apparent that tight control of blood glucose, or A1c (the measure of blood glucose over time) might be much less important than we had believed for decades. Tight control might be doing more harm than good for some older adults,”.
Dr. Anshula Ambasta, Assistant Professor in the UBC Department of Anaesthesiology, Pharmacology & Therapeutics, and a specialist in internal medicine at St. Paul’s Hospital in Vancouver adds:
“We now have compelling evidence that newer drugs work by complex mechanisms unrelated to blood sugar control to reduce the health impacts of type 2 diabetes.”
“On the other hand, we know that glyburide or gliclazide (oral sulfonylurea drugs) and insulin cause dangerous hypoglycemia in many patients. This can cause falls, accidents, mental confusion or other harmful effects.”
The UBC TI collects confidential data for individual prescribers under strict Ministry of Health rules that guarantee the privacy of patients and clinicians. During the first half of 2024, over 126,000 British Columbians, including more than 71,000 older than 65, took a sulfonylurea or insulin. Although these numbers include people with type 1 diabetes who depend on insulin, the majority have type 2 diabetes, in whom insulin may not be required.
Dr. Wade Thompson notes that frail patients are at highest risk from harmful effects of sulfonylureas and insulin:
“Our Therapeutics Letter calls on BC clinicians to rethink whether prescribing these drugs is still a good idea for their type 2 diabetic patients – particularly those with tightly controlled blood glucose.”
(Note: type 2 diabetes differs from type 1 diabetes – for which insulin is life-saving.)
Dr. Jessica Otte, a Nanaimo family doctor and UBC Clinical Associate Professor of Family Practice, explains that the Therapeutics Letter 151 is part of a continuous quality improvement project for primary care doctors and nurse practitioners in BC: the Prescribing PORTRAIT.
“Our individualized portraits provide clinicians with a confidential map of their own prescribing for important drug categories. Over 1,000 family doctors and nurse practitioners are now participating voluntarily in the BC prescribing PORTRAIT project. They can see how their prescribing for their own patients compares with what is probably optimal. Eventually, we hope to enrol the majority of primary care practitioners, including prescribing pharmacists
“So far we have seen that our PORTRAIT approach was effective at improving treatment of UTIs on a province-wide scale, assisting in the fight against antimicrobial resistance.”
The bottom line of Therapeutics Letter 151 is that for most older adults (65 years or older) with type 2 diabetes who have an A1c below 7%, sulfonylureas or insulin do more harm than good. Read more.
The TI Methods Speaker Series continues this month with a webinar presentation from “down under” on Wednesday, October 23rd, 2024 at 4:00 PM PDT [convert to your local time]: in a webinar titled Common Errors in Meta-Analyses and Meta-Regressions in Strength & Conditioning Research, Dr. Daniel Kadlec from Edith Cowan University in Perth, Australia, will review common statistical errors in meta-analyses and will document their frequency in highly cited meta-analyses from strength and conditioning research. Examples of errors (and solutions) in areas of particular interest in sport science will be presented and discussed. Read more about this free webinar or REGISTER to reserve your spot.
Here is a sneak peek at some of our offerings next month:
- on Wednesday, November 6 at 12:00pm noon PST we will be hosting a TI Best Evidence webinar in which Hafeez Dossa, a pharmacist who manages a pharmacy that supports about 2,000 patients in long term care and assisted living facilities across Vancouver Island, will share his team’s experience implementing a pilot project of pharmacist-led deprescribing of tramadol in long-term care. Read more or REGISTER.
- And the last webinar of the year in the TI Methods Speaker Series will take place on Wednesday, November 27 at 12:00pm noon PST, when Dr. Carole Lunny will discuss a new Risk of Bias Tool for Network Meta-Analysis. Registration opens soon, so stay put and in the mean time save the date!
2024 Annual Course: Bringing Best Evidence to Clinicians
To mark the 30th anniversary of the Therapeutics Initiative, we’re excited to introduce a unique format for this year’s event, with an in-person gathering on Friday, October 18, followed by hybrid (virtual and in-person) sessions on Saturday, October 19. Those who attended in the past know that the audience is as lively and fun to interact with as the speakers. And the conference hotel rate of $169/night (plus taxes, parking) is now a very attractive rate for a visit to Vancouver. But you can also attend online by Zoom.
This year’s course features two internationally renowned guest faculty with rave reviews from past audiences in Vancouver and online:
- Dr. Derelie (Dee) Mangin is a leading research professor in Family Practice, originally from New Zealand and now at McMaster University. She is one of the rare physicians who has run trials of deprescribing. Dee can be as funny as she is friendly, and this is a great opportunity for anyone to meet her during our Friday evening pre-course reception or on Saturday, October 19th.
- Dr. John Mandrola is an experienced cardiac electrophysiologist who has won international appreciation for his communication skills in dissecting and logically analyzing what we know and do not know from clinical trials. He’s as friendly and approachable as Dr. Mangin.
Of course our own TI faculty are not easily outdone. We guarantee that this course will make you think – and hopefully re-think some of what you do. But whether you’re a NP, pharmacist, physician, or student/resident, we’ll also provide you with practical trips to improve patient care. The course will culminate in a panel discussion on Saturday afternoon: “What are your picks for essential drugs in Canada”. The panel discussion will feature the two guest speakers (Dr. Dee Mangin and Dr. John Mandrola), Dr. Mina Tadrous, Assistant Professor at the University of Toronto’s Leslie Dan Faculty of Pharmacy and Canada Research Chair in Real World Evidence and Pharmaceutical Policy, and Dr. Wade Thompson and Dr. Tom Perry from the Therapeutics Initiative.
On Friday afternoon, October 18th, we also offer a specialized small-group Practical Deprescribing Workshop. If you face challenges in dealing with polypharmacy, or wonder if you could gain professional satisfaction by sometimes going “where others fear to tread,” this workshop is for you. It’s designed to interest and assist any health professional involved with medications – from student or resident to even a very experienced practitioner.
By working with UBC CPD, we keep fees to the minimum possible – to promote affordable access. In person registration fees cover lunch and refreshments on Saturday, and a refreshment break on Friday. If you can’t afford the fee, let us know: we will consider offering a subsidy.
This year’s course is hosted at UBC Robson Square in downtown Vancouver, a central location that offers convenient access to nearby popular attractions, making it an ideal location for attendees and family members to explore the city’s offerings outside of conference hours.
Read more about this year’s course or REGISTER.
If you are a BC family physician or nurse practitioner, we invite you to join over 1,000 of your BC colleagues who have signed up for the TI Portrait program at our secure online portal: https://secure.ti.ubc.ca/ Log in to view your Portraits and/or related materials, or sign up if you haven’t already.
Questions? Email the TI Portrait team at portrait@ti.ubc.ca We welcome your feedback.
We hope you will find something of interest among he various things we are offering this month If you attend one of our upcoming events, we hope you will introduce yourself to all of us faculty. And we always welcome comments and suggestions.
Thomas L. Perry MD, FRCPC
Editor, Therapeutics Letter
Therapeutics Initiative
University of British Columbia, Vancouver
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