2026 Southeastern Residency Conference

Authors: Tsuraya Iswanto, Mariam Saba, Victoria Phan

Background: Resmetirom, a selective agonist of THR-β in the liver, received FDA accelerated approval in March 2024 for treatment of metabolic dysfunction-associated steatohepatitis (MASH) with stage F2-F3 fibrosis. Patients prescribed on resmetirom often have comorbidities of hypertension, dyslipidemia, and diabetes. As a limited distribution drug, resmetirom is dispensed only through select specialty pharmacies. Due to its recent approval, adherence and side effect data are limited, creating an opportunity for retrospective data analysis to identify therapy-related barriers and guide interventions.

Methods: This will be a retrospective data analysis (from March 2025 to April 2026) involving patients who were prescribed with resmetirom, have a diagnosis of MASH, and had an initial fill and refills from a community-based specialty pharmacy. Patients will be included in this study if they are prescribed resmetirom and have a documented prescription refill record for at least 5 months. Patients will be excluded from the study if they have been on resmetirom for less than 6 months. Adherence will be analyzed using Proportion of Days Covered (PDC) scores. Patients must have had at least 6 total fills (or 180 days) of therapy for PDC scores to be calculated. The pharmacy dispensing system data with dates of the initial fill and refills will be used for PDC scores. PDC scores will be categorized into two adherence groups: PDC scores will be categorized into two adherence groups: > 98% and < 98%. Therapy outcomes will be assessed by self-reported health status shared by the patient during 6-month therapy reassessments. From pharmacy reassessments calls, the following data will be collected: 1. Data including patient reported side effects 2. Perceived effectiveness of resmetirom in managing MASH treatment 3. Missed doses 4. Challenges while taking resmetirom related to drug therapy • For drug interactions, the pharmacist will identify patients who are on medications that require pharmacist intervention due to major interactions with resmetirom (Statins, CYP2C8 inhibitors, or other hepatotoxic medications).

Results (preliminary results): Overall adherence was high, with a mean PDC of 98.17% and 65.3% of patients classified as highly adherent (≥98%). Patients with ≥98% adherence demonstrated a higher proportion of positive perception compared to those with lower adherence. Adherence showed a non-significant trend towards improved positive perception (OR = 1.54, p = 0.47) and reduced side effects (OR = 0.52, p = 1.00). Confidence intervals were wide, indicating high uncertainty. No statistically significant associations were observed.

Conclusions (reached to date): Adherence to resmetirom therapy was high, and patient-perceived effectiveness was positive. Higher adherence (≥98%) showed trends toward more positive perception (OR 1.54) and fewer side effects (OR 0.52), however were not statistically significant. Limited variability and small sample size likely reduced power to detect associations. These findings can help specialty pharmacists identify strategies that can be implemented to improve therapy outcomes by identifying potential barriers to continuing therapy.

E-mail of resident: [email protected]

Authors: Alexa Ruzicka, Magen Check, Austin Weiss, Tamara Downing, Ashlee Baucom 

Background:  
Diabetic ketoacidosis (DKA) is a serious complication of insulin deficiency and a leading cause of hospitalization and mortality among children with type 1 diabetes mellitus (T1DM). Intravenous fluid resuscitation is a critical component of DKA therapy. However, fluid therapy in children carries unique risks, most notably cerebral edema. To mitigate these risks, current pediatric guidelines recommend gradual correction of hyperglycemia and acidosis using continuous insulin infusion and staged fluid replacement. Many institutions utilize a two-bag method, which allows for rapid titration of dextrose concentration while maintaining a continuous insulin infusion and consistent electrolyte delivery. The composition of the standard DKA bags used in the two-bag protocol was changed at the study institution in June 2024. The purpose of this study was to compare clinical outcomes before and after the implementation of the revised two-bag fluid composition for pediatric DKA.  

Methods: 
This study is an institutional review board approved, single center, retrospective cohort study. Pediatric patients (≤ 17 years of age) with a diagnosis of T1DM admitted to the PICU for management of DKA between June 1, 2023, and July 1, 2025, were eligible for inclusion. DKA was defined according to institutional and International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria. Patients were excluded if custom IV fluid bags were utilized during DKA management. The primary endpoint was the time (in hours) from initiation of IV insulin infusion to transition to subcutaneous insulin therapy, which was a surrogate marker for DKA resolution. Secondary outcomes included time to DKA resolution, defined by biochemical markers including serum bicarbonate, anion gap closure, venous pH and beta-hydroxybutyrate. Additional secondary outcomes included PICU and total hospital length of stay, and incidence of cerebral edema, hypoglycemia and hyperchloremia. Mann-Whitney U tests were used to evaluate baseline characteristics, time to DKA resolution, and length of stay. Chi-squared tests were utilized to evaluate the incidence of treatment-related complications.  

Results: 
109 pediatric patients met inclusion criteria. There were 44 patients and 65 patients in the previous and current bag composition groups, respectively. Baseline characteristics were similar between groups. The median time to transition to subcutaneous insulin was shorter in the current bag composition group compared to the previous bag composition group (11.98 hours vs 13.75 hours, p = 0.174). There was no statistically significant difference in the biochemical endpoints of DKA resolution between groups.  
Rates of treatment-related complications were comparable between groups. The incidence of severe hypoglycemia (< 70 mg/dL) was low in both cohorts (2% vs 3%, p = 0.523), with moderate hypoglycemia occurring at a higher rate (< 100 mg/dL) (23% vs 37%, p = 0.117). Hyperchloremia occurred at a similar rate in both groups (82% vs 83%, p = 0.865). There were no statistically significant differences in cerebral edema (2% vs 6%, p = 0.342) or new-onset T1DM (36% vs 28%, p = 0.338). There were no significant differences observed in PICU length of stay (26.16 vs 27.32 hours, p = 0.91). However, the total hospital length of stay was longer in the current bag composition group (33.9 vs 35.6 hours, p = 0.03).

Conclusion: 
The modification of the two-bag IV fluid composition for pediatric DKA did not result in significant differences in time to DKA resolution, complication rates, or PICU length of stay. Hospital length of stay was longer in the current bag composition group.  

Contact email: [email protected]

Title: Patient-Reported Outcomes with Semaglutide Sublingual Suspension for Wellness: A Prospective Observational Study.  

Authors: Jonathan Reynolds; Brandon Sucher  

Background:  
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have increased in use for the treatment of obesity. This class of medications is associated with weight loss through activation of GLP-1 receptors, which delays gastric emptying and increases satiety. While effective for weight loss, injectable GLP-1 RAs are associated with gastrointestinal side effects, high cost, and the need for subcutaneous injections. In December 2025, semaglutide 25 mg oral tablets were approved by the FDA for the treatment of obesity, providing an alternative formulation for patients. The OASIS-4 clinical trial evaluated the use of semaglutide 25 mg oral tablets dosed once daily for 64 weeks in overweight or obese adults.  At the conclusion of this study, the mean percent change in body weight from baseline to week 64 was -13.9%, and the proportion of patients with a weight loss greater than 5% was 79.2%. The most common adverse effects were nausea (46.6%), vomiting (30.9%), constipation (20.1%), dyspepsia (18.1%), and diarrhea (17.6%).  Allergic reactions occurred in 3.9% of patients. Health care providers have prescribed compounded semaglutide sublingual (SL) suspension as an alternative to injectable GLP-1 RAs.  This study aims to evaluate patient-reported outcomes from patients prescribed compounded semaglutide SL suspension.  

Methods:  
This prospective observational study utilized patient reported outcomes obtained from patients prescribed compounded semaglutide SL suspension from March 2025 to February 2026.  All adult patients who received a prescription for compounded semaglutide SL suspension within a network of 20 compounding pharmacies were eligible. Eligible patients were emailed a link to complete a patient-reported outcome measure (PROM). Patients who did not initially complete the PROM received up to two reminder emails. There were no exclusion criteria for this study. The primary endpoint was the mean percent change in body weight from baseline. Secondary endpoints included overall satisfaction, post-meal fullness, adverse drug reactions, allergic reactions, and the proportion of patients achieving weight loss greater than 5%. Descriptive statistics were used to report data. 

Results:
A total of 382 PROMs were emailed to patients, and 47 responses were received (12.3% response rate). The median dose reported was 4 mg SL once daily, and the median duration of therapy was 2 to 3 months.  The mean percent change in weight was -1.9%.  The median overall satisfaction reported was “somewhat satisfied,” and the median post-meal fullness was “moderately full.” Of the 47 patients, 8 (17%) achieved a weight loss greater than 5%. Two patients (4%) reported adverse reactions. One patient experienced constipation, headache, and fatigue, while the second patient experienced tooth sensitivity. Two patients experienced allergic reactions (4%), with one resulting in treatment discontinuation. One patient reported difficulty performing daily activities. The allergic reactions reported were not life-threatening and did not require hospitalization.  

Conclusion: 
Compounded semaglutide SL suspension at a median dose of 4 mg once daily was associated with a weight loss of 1.9% over a median duration of 2 to 3 months. The proportion of patients achieving weight loss greater than 5% was 17%. Patients reported a median level of overall satisfaction as “somewhat satisfied,” and a median post-meal fullness of feeling “moderately full.” Compounded semaglutide SL suspension demonstrated a favorable safety profile with a low incidence of reported adverse effects (4%) and allergic reactions (4%). While some benefit was seen, higher doses and a longer duration of compounded semaglutide SL suspension may demonstrate more favorable patient-reported outcomes.

Title: Comparison of Heart Rate and Blood Pressure Control Agents in Acute Aortic Dissection
Authors: Brianna Lu, Kathryn Harvell, Ginger Gamble
Background: Anti-impulse therapy is the cornerstone of acute aortic dissection management to prevent rupture or dissection extension and has been shown to decrease long-term aorta-related adverse events. The American Heart Association/American College of Cardiology and European Society of Cardiology recommend a goal heart rate (HR) between 60 and 80 beats per minute and a goal systolic blood pressure (SBP) less than 120 mmHg. Current guidelines recommend beta blockers as initial therapy to achieve goal HR and BP; however, this is muddled by the absence of guideline-directed hierarchies within each drug class and lack of clear criteria for when therapy should be modified.
Methods: This single-center, retrospective, observational analysis identified patients 18 years or older treated for acute aortic dissection at an academic medical center from January 1, 2021 to October 1, 2025 and received intravenous labetalol, esmolol, nitroprusside, nicardipine, clevidipine, diltiazem, or verapamil. The primary outcome was the percent of patients with treatment failure, defined as switching study drugs, death prior to operative intervention, or not at goal HR (less than or equal to 80 bpm) and SBP (less than 120 mmHg) at 3 hours.  Statistical analyses include Fisher’s Exact for categorical variables and Mann Whitney-U for continuous variables.
Results: A total of 56 patients met inclusion criteria, and 38 patients were included in the final analysis. Thirty (88%) patients who received esmolol and 3 (75%) patients who received labetalol failed treatment at 3 hours (p = 0.45). At 6 hours, 27 patients who received esmolol and 3 patients who received labetalol failed treatment (p > 0.99). The median time to switch agents was 4.67 hours versus 3.64 hours in the esmolol and labetalol groups (p = 0.69). There was a difference in median time to first goal HR for esmolol at 0.47 hours compared to 0 hours in the labetalol group (p = 0.02). In contrast, there was no difference in median time to first goal SBP or in the percent of HR or SBP readings at goal at either 6 hours or 24 hours. Four patients (11.7%) died in the esmolol group compared to none in the labetalol group. The median intensive care unit length of stay was 4.05 days and 7.55 days for the esmolol and labetalol groups, respectively. A subgroup analysis comparing patients who received esmolol only (n = 11) versus labetalol found no difference in treatment failure rates at 3 hours (p = 0.47) or 6 hours (p > 0.99).
Conclusion: This study suggests there is no difference in treatment failure rates between esmolol and labetalol used for the management of acute aortic dissection at this institution. Secondary outcomes suggest that there may be benefit in the implementation of protocols to assist with optimizing titration of study drugs to achieve goal HR and SBP in a timelier fashion. Additional studies may be warranted to evaluate other differences in clinical outcomes between esmolol and labetalol.
Contact Information: [email protected]

Impact of Daptomycin Weight-Based Dosing Strategies in Obese Patients with Staphylococcal and Enterococcal Infections
Coleton Waggoner, Emily Perez, David Laurent
Background: High-dose daptomycin (>8 mg/kg) is increasingly utilized for severe Staphylococcus aureus and Enterococcus infections. However, optimal weight-based dosing in obese patients remains undefined. Daptomycin exposure is nonlinear with weight, and consequently, obese patients may be at risk for excessive exposure and adverse outcomes when dosing by total body weight (TBW).

Methods: This multicenter retrospective cohort study evaluated hospitalized adult obese patients (BMI ≥30 kg/m²) treated with high-dose daptomycin at ECU Health from January 2022 to July 2025. Patients were categorized into TBW or ABW (adjusted body weight) cohorts as determined by infecting pathogen: 8-10 mg/kg ± 0.5 mg/kg for S. aureus or 10-12 mg/kg + 0.5 mg/kg for Enterococcus spp.

The primary outcome was a composite safety endpoint of serum creatinine kinase (CK) elevation (>600u/L), patient-reported myopathy, rhabdomyolysis, or early discontinuation of daptomycin. Secondary outcomes included individual components of the composite safety endpoints as well as efficacy endpoints including readmission at 90 days, mortality at 90 days, resistance development at 90 days, and daptomycin discontinuation due to lack of efficacy. Baseline characteristics and outcomes were compared between groups using chi-square or Fisher’s exact tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results: A total of 101 patients were included (TBW n=40; ABW n=61). Several differences in baseline characteristics existed between groups; the ABW cohort was significantly older (60.8 vs 56.1 years; p=0.025), had a higher mean BMI (38.7 vs 36.1 kg/m2; p=0.041), and had a higher prevalence of concomitant statin use (45.9% vs 20.0%). The primary composite safety outcome occurred in 20.0% (n=8/40) of TBW vs 19.7% (n=12/61) of ABW patients (p=0.78). CK elevation occurred in 20.0% vs 16.4% (p=0.59), myopathy in 5.0% vs 4.9% (p=1.00), and rhabdomyolysis in 2.5% vs 0% (p=0.39) in TBW and ABW groups, respectively. Discontinuation due to safety concerns occurred in 15.0% vs 8.2% (p=0.34). Ninety-day mortality was 20.0% vs 16.4% (p=0.64). There were no significant differences in secondary outcomes.

Conclusions: In this cohort of obese patients receiving high-dose daptomycin, TBW and ABW based dosing strategies demonstrated similar rates of composite safety events, as well as exploratory efficacy outcomes.

Email: [email protected]

Evaluating Provider Behavior Around Alternative Fluid Orders During the 2024 IV Fluid Shortage
Authors: Cady Thomas, Jennifer Peltz, Christopher Dennis
Practice site: ECU Health 
Contact: [email protected]


Background: In September 2024, Hurricane Helene hit the western part of North Carolina and caused damage to a Baxter manufacturing plant which produces multiple sterile IV fluid products. Most health systems across the US relied on this plant for at least a portion of their IV fluid needs. Damage to the plant led to a major IV fluid shortage across the country. ECU Health utilized a series of medication alternative alerts to provide guidance to providers that were ordering IV fluid products during the shortage. Providers were allowed to select from the approved alternative list or to cancel the orders. The list of alternatives established limits on the amount of fluid that could be ordered and the duration of the orders. After selecting an option from the alternative list, providers had the ability to deviate from the recommendations by modifying order details before signing the orders. The purpose of this study was to evaluate the effectiveness of the medication alternatives in guiding ordering practices and to identify patterns in provider behaviors surrounding use of the tools throughout ECU Health. To establish a baseline expectation for alternative performance during shortages, we referenced prior studies with comparable clinical decision support designs. Sandler et al. reported alternative acceptance in 4.8% of cases and order cancellation in 6.2%.1​​​​ When combined, 11.1% of provider actions resulted in a desired outcome (recommended use accepted or no use), a rate we define as non-deviation for the purposes of our analysis. Whether similar outcomes occur around alternative fluid orders in other health systems is unclear.

Methods: The health system’s Clarity database was queried to identify all instances of medication alternatives triggered for IV fluids that were on shortage between October 9, 2024 and January 13, 2025. To better understand provider behavior and clinical impact, alternatives were then grouped into episodes which serve as the primary unit of evaluation for this study. 15,774 IV fluid episodes were included for analysis. The primary objective was to compare the proportion of episode non-deviations at our institution with rates previously reported in the Sandler et al. study. Episodes resulting in orders with deviations were further categorized by waste production and time deviations. Episodes were also categorized by provider type, type of IV fluid ordered, source of the order, hospital location of order origin, and patient age. The rate of non-deviation in our cohort was compared with the rate reported by Sandler et al. using a Chi-square test of independence. Descriptive statistics were used to describe other data points collected.

Results: Among 15,774 episodes, the non-deviation rate was 86.3% in our cohort compared with 11.1% in the comparator study, representing an absolute difference of 75.2% (95% CI 74.3 –76.1). This difference was statistically significant (χ²(1) = 12,203.007, p < 0.001). Of the episodes that resulted in deviations, 181 episodes resulted in time deviations; 2,034 episodes resulted in waste deviations. It was estimated that 815 L of fluid was wasted because of order deviations.  

Conclusion: Deviation from recommended alternatives occurred less frequently in our study compared with a prior alternative order study, though direct comparison is limited by differences in clinical context.  While our study shows a statistically significant improvement, the vast majority of episodes indicate providers still choose to deviate from the alternative recommendations which resulted in substantial IV fluid wastage. By recognizing prescribing patterns in areas that were more impacted by order deviations during the IV fluid shortage, the institution can employ additional strategies to help further minimize orders that deviate from recommendations.  


1. Sandler M, Cavanaugh J, Walton T, Cavendish L, Shah K. Management of an i.v. fluid shortage through use of electronic medical record alerts. American journal of health-system pharmacy. 2020;77:546-551.

Background: Staphylococcus aureus is one of the most clinically significant bacterial pathogens and can cause a wide range of infections, from mild skin and soft tissue infections to invasive bloodstream infections with severe complications. The standard of care for methicillin-susceptible S. aureus (MSSA) bloodstream infections has been an antistaphylococcal penicillin or a first-generation cephalosporin, such as cefazolin (CZ). Recent literature has shown no efficacy difference between CZ and antistaphylococcal penicillins, but has shown that CZ may be associated with less side effects. This has led to CZ becoming the preferred agent for MSSA bacteremia at our institution. MSSA is also covered by most broad-spectrum β-lactams, including piperacillin-tazobactam (TZP), cefepime (FEP), ertapenem (ETP), and meropenem (MEM). These broad-spectrum agents are primarily used for their activity against Pseudomonas aeruginosa or pathogens at high risk for inducible AmpC production, such as Enterobacter cloacae or Klebsiella aerogenes. Of note, ETP lacks anti-pseudomonal coverage but is used for treatment of other resistant pathogens, such as extended-spectrum β-lactamase (ESBL) producing organisms. In cases of polymicrobial infections, these broad-spectrum β-lactams may be used as targeted therapy for MSSA in addition to the gram-negative pathogens. These agents are also sometimes used in neutropenic patients to treat MSSA while maintaining anti-pseudomonal prophylaxis when indicated. While in vitro activity is expected, there are limited data examining the clinical outcomes of these broad-spectrum β-lactams as targeted therapy for invasive MSSA infections.

Methods: This was a system-wide, retrospective, cohort study conducted at ECU Health assessing hospitalized adults with MSSA bacteremia. Included patients were treated with ≥ 7 days of monotherapy CZ or one of the following broad-spectrum β-lactams: TZP, FEP, ETP, or MEM between August 2019 and December 2025. Patients were excluded if they had MRSA isolated or if they received other antibiotics active against MSSA while receiving the study drug. Patients were identified using SlicerDicer within EPIC and then screened for inclusion. The primary outcome was treatment failure, defined as a composite of 90-day all-cause mortality, 90-day hospital re-admission, and 90-day recurrent MSSA bacteremia. Secondary outcomes included the individual components of the primary outcome at 30 days and 90 days, 90-day C. difficile infections, and new multidrug-resistant organisms isolated within 90 days.

Results: 1,435 patients with S. aureus blood cultures from August 2019 to December 2025 were screened. Of these, 33 patients on broad-spectrum β-lactams were eligible for inclusion (TZP=12, FEP=9, ETP=6, and MEM=6). 33 patients on CZ were then identified for balanced sample sizes, with a total of 66 patients included in the analysis. Average age, BMI, and duration of therapy, were similar between the two groups. The most common reason for exclusion was receiving the study drug for < 7 days (62%). Patients in the broad-spectrum group had nearly twice as long hospital length of stay compared to the CZ group (31 vs 17 days). Patients treated with broad-spectrum β-lactams were more likely to meet the 90-day primary outcome compared to those treated with CZ (OR 0.29; 95% CI 0.10-0.79; p=0.01). This was primarily driven by reduced 90-day mortality and 90-day re-admission.

Conclusion: This study showed a significant benefit in patients that received CZ over broad-spectrum β-lactams in the treatment of MSSA bacteremia. This study adds to the small amount of data comparing outcomes in patients with MSSA bacteremia treated with broad-spectrum β-lactams. Larger, prospective studies are warranted to further explore the most optimal broad-spectrum β-lactam for MSSA when additional coverage is needed.

Impact of GLP-1/GIP Receptor Agonists on HF-Related Hospitalizations 

Investigators: Haley Jones, PharmD; Erika Schoenborn, PharmD, BCCP, CPP; Kacy Whyte, PharmD, BCPS, BCCP
Practice Site: ECU Health Medical Center, Greenville, NC
Email: [email protected]

Purpose: Despite advances in guideline directed medical therapy (GDMT), many patients with heart failure (HF) experience persistent symptoms and recurrent hospitalizations. The intersection of HF and metabolic disease is of particular clinical importance, as type 2 diabetes mellitus (T2DM) and obesity are common comorbidities across the HF spectrum and are associated with worse clinical outcomes. Glucagon-like peptide receptor agonists (GLP-1 RAs) are an established treatment for T2DM and have recently gained prominence for their benefits in weight reduction and cardiovascular risk reduction. GLP-1 RAs reduce major cardiovascular events in patients with HFpEF, but conflicting evidence exists on the safety and efficacy in HFrEF. Further investigation is warranted to clarify their role in HF management. The purpose of this study was to assess the association between use of GLP-1 RAs and rate of HF-related hospitalizations for patients with HF.  
Methods: This retrospective cohort study included adult patients hospitalized with HF between January 1, 2024, and December 31, 2024. Patients were stratified by LVEF and by receipt of GLP-1 RA therapy. The primary endpoint was the rate of 30-day HF-related readmissions among patients receiving GLP-1 RA compared to those not receiving these medications. Secondary endpoints included 90-day HF-related readmission rates, time to first HF-related hospitalization, change in body weight during the study period, all-cause mortality, and administration of IV diuretics within 90 days. Patients were identified using SlicerDicer based on HF-hospitalizations within the study period, with outpatient prescriptions for a GLP-1 RA (tirzepatide or semaglutide) used to define the treatment group. Data were analyzed using descriptive statistics, Chi-Square, and Mann-Whitney U tests, as appropriate.  
Results: A total of 407 patients were screened for inclusion, with 106 patients included in each group. The median age was 69 yrs (IQR 60-77), 52% female, and 53.3% black patients. A total of 22 patients (20.7%) in the treatment group experienced 30-day HF-related readmission, compared with 19 patients (17.9%) in the control group (p = 0.60). Among patients with HFrEF, 30-day readmission occurred in 11 patients (22.9%) in the treatment group and 6 patients (15.8%) in the control group (p = 0.41). At 90 days, HF-related readmission occurred in 38 patients (35.8%) in the treatment group and 41 patients (38.7%) in the control group (p = 0.63). Median time to first HF-related hospitalization was 25 days (IQR 12-64) in the treatment group and 38 days (IQR 15-62) in the control group (p = 0.55). All-cause mortality occurred in 8 patients in the treatment group and 9 patients in the control group (p = 0.80). 
In the HFrEF subgroup, increased diuretic doses at 30 days were observed in 27 patients (60.0%) in the treatment group compared with 15 patients (40.5%) in the control group (p = 0.20), and at 90 days in 24 patients (58.5%) versus 14 patients (41.2%), respectively (p = 0.203). In the HFpEF/HFimpEF group, increased diuretic doses at 30 days occurred in 16 patients (37.2%) in the treatment group and 20 patients (41.7%) in the control group (p = 0.91), and at 90 days in 15 patients (37.5%) and 20 patients (46.5%), respectively (p = 0.62). 
Conclusions: In this retrospective analysis of patients with HF, GLP-1 RA therapy was not associated with differences in 30-day or 90-day HF-related readmission rates compared with no GLP-1 RA use. Although not statistically significant, a higher proportion of patients with HFrEF receiving GLP-1 RAs required increased diuretic dosing at 30 and 90 days, a pattern not observed in patients with HFpEF/HFimpEF. These findings suggest potential differences in clinical response by ejection fraction and highlight the need for further investigation into the safety and role of GLP-1RA in patients with HFrEF.  

Title: Impact of Health-System Community Pharmacists on Adherence for Medicare Advantage Plan Members 
Primary Author: Heather Vance 
Co-Authors: Catie Harper 
Practice Site: Cone Health Community Pharmacies and Triad HealthCare Network
Background: 
The Centers for Medicare and Medicaid Services (CMS) indicates quality of Medicare plans using a star-rating system, with one being the lowest and five being the highest. Three of the measures included in the star-rating system relate to patient medication adherence, including medication adherence to statins. CMS defines adherence as a proportion of days covered (PDC) of 80% or more.
Cone Health participates in value-based care agreements with payers to improve the quality of care provided to patients. Additionally, Cone Health sponsors a Medicare Advantage plan with Part D prescription drug coverage.
Through continuous evaluation, our organization identified that patients using integrated health-system pharmacies had improved medication adherence compared to outside pharmacies. Proactively, Cone Health began targeting patients failing or at risk of failing the statin adherence measure using health-system pharmacies to characterize the impact of targeted community-pharmacist intervention on plan member adherence.
Methods: 
This is an IRB reviewed, determined exempt, retrospective pre-post study evaluating medication adherence among members of a Medicare Advantage plan. Included patients were active plan members in 2025, with one or more statin fills at an integrated pharmacy, with Medication Adherence for Cholesterol measure PDC of 85% or less through the end of July 2025, identified through reports provided by the plan. Excluded patients were deceased, filling at non-health-system pharmacies, transitioned to hospice, or had therapy discontinued by their provider. The percentage of patients with PDC > 80% pre-intervention compared to post-intervention was the primary outcome, evaluated with McNemar’s Test. The number/type of pharmacist intervention was the secondary outcome, evaluated with descriptive statistics.
Patients received telephonic and electronic communication from the primary investigator regarding their prescribed statin therapy. After 3 unsuccessful attempts, patients were considered lost to follow-up. An adherence interview was conducted to assess understanding, tolerability, need for referral, and barriers to adherence. Patients were enrolled in appropriate adherence services. After enrollment, patients were contacted before their next refill to ensure sustained adherence.
Results: 
Of the 53 eligible patients, 19 patients were excluded. At baseline, the average age was 73.7 years, 50% of patients had clinical ASCVD, 55.9% had an LDL < 70 mg/dL, 50% had a PDC score of 65-79.9%, and 26.5% with PDC < 65%.
At baseline, 23.5% (n = 8) patients were considered passing the MAC measure with a PDC score > 80% compared to 41.2% (n = 14) after study completion. Of these patients, 7 were initially failing the MAC measure at baseline and were converted to passing. The final percentage of patients failing the MAC measure after study completion was 58.8% (n = 20), 19 of which were initially failing at baseline.
A total of 73 interventions were completed over the course of this study, with 53 conducted in the PDC < 80% group. The most common intervention was refilling other medications (n = 24), refilling targeted medication (n = 13), and leaving a voicemail with returned call (n = 13). The most common adherence service provided was automatic-refill enrollment (n = 5).
Conclusions: 
There was not a statistically significant difference between PDC scores among patients during pre- and post-intervention. This study encouraged the development of an adherence monitoring platform to ease monitoring and intervention for population health pharmacists. In the future, a single investigator driven intervention may not be sufficient to improve patient adherence, especially among larger cohorts.

Title: Evaluation of Safety Outcomes in Patients with Diabetes Receiving Perioperative Dexamethasone  

Investigators: Christian Garner, Devon Johnson, Spencer Livengood
Practice Site: ECU Health Medical Center 
Contact: [email protected]

Background: Postoperative nausea and vomiting (PONV) occurs in ~30% of surgical patients and is more common in high-risk procedures. Intravenous dexamethasone is often utilized for PONV prophylaxis but may increase the risk of hyperglycemia in patients with diabetes. At ECU Health Medical Center (ECUHMC), cases of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) have been observed following perioperative dexamethasone use. However, the incidence of these complications remains poorly described in current literature. This research project aimed to evaluate the incidence of DKA and HHS in patients with diabetes receiving perioperative dexamethasone and identify associated risk factors for postoperative insulin drip initiation. 

Methods: This single-center, retrospective observational review evaluated adult patients with diabetes who underwent surgery and received perioperative dexamethasone at ECUHMC from July 2024 to July 2025. Patients were excluded for conditions likely to confound glycemic outcomes, including chronic steroid use, perioperative insulin infusion, or administration of additional steroids. The primary outcome was the incidence of postoperative DKA or HHS as defined by the 2026 American Diabetes Association. Secondary outcomes included hospital length of stay and mean 72-hour postoperative blood glucose levels. Descriptive statistics were used to summarize primary and secondary outcomes. A multivariate analysis was used to identify an association between independent variables and insulin infusion initiation. 

Results: Of 1,450 patients screened, 381 met inclusion criteria. Two patients (0.5%) developed confirmed DKA, and no cases of HHS were identified. Median postoperative length of stay was 92.2 hours and mean 72-hour postoperative blood glucose was 172 mg/dL, with 65.9% having a 24-hour postoperative blood glucose >200 mg/dL. Seventeen patients (4.5%) required initiation of an insulin infusion within 72 hours of dexamethasone administration but were missing necessary information to confirm DKA or HHS diagnosis. Results from the multivariate analysis confirmed higher admission blood glucose was independently associated with insulin infusion initiation (p=0.0435).  

Conclusion: Although perioperative dexamethasone use was associated with a low incidence of confirmed DKA and HHS, a notable proportion of patients required insulin infusion, indicating a higher burden of postoperative hyperglycemia and potential under-recognition of hyperglycemic crises. Elevated preoperative blood glucose levels were associated with increased risk of insulin infusion initiation, supporting closer perioperative glucose monitoring in patients with diabetes.