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Diabetes, cardiovascular disease and dementia news published this month reinforces the need for pharmacists working with long-term conditions to take a holistic approach to patient care.
Meanwhile, new research on cancer drugs has been published this week — but pricing disagreement over branded medicines could impact the availability of high-cost drugs on the NHS, industry has warned.
Stigma affects most diabetes patients — and impacts their wellbeing
Diabetes medications now account for 15% of all NHS England prescription spending, with costs having risen by 18% in the past year, according to NHS Business Services Authority (NHSBSA) data. Over the past decade, the number of people identified as receiving treatment with diabetes medicines has increased by 43%, from 2.7 million patients in 2015/2016.
However, a survey by Diabetes UK has found that almost 9 in 10 people with type 1 diabetes — and 7 in 10 people with type 2 diabetes — experience blame and judgement for their condition. It also found that those who experience or internalise stigma are more likely to report depressive symptoms, anxiety symptoms, diabetes distress and lower self-esteem.
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Sex differences in cardiovascular risk
Meanwhile, a study, which is due to be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria (15–19 September), highlights key sex differences in cardiovascular risk between diabetes types: younger men have higher risk for mortality and cardiovascular disease for type 2 diabetes than type 1 diabetes; whereas for women, type 1 diabetes outcomes are worse at all ages.
A study based on UK biobank data has also found sex differences in cardiovascular risk, based on the location of body fat. Visceral adipose tissue — fat which is often invisible from the outside but is found deep inside the abdomen around organs such as the stomach, intestines and liver — was linked to faster heart ageing, the biggest risk factor for heart disease, the researchers found. But fat around the hips and thighs could potentially slow heart ageing in women, the study suggested.
Hormones could also protect against heart disease, since higher oestrogen levels in premenopausal women was linked to a slowing of heart ageing, the Medical Research Council (MRC) study suggested. Meanwhile, statin use in the first trimester of pregnancy has been found to have no statistically significant association with congenital malformations, according to a Norwegian nationwide study.
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New BNF guidance for apixaban, COVID-19 and malaria
BNF has updated apixaban guidance around the structure of dosing and renal impairment dose adjustments for prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation and at least one risk factor. There is also updated guidance around the treatment of malaria and symptomatic management of cough, and anxiety and agitation in COVID-19.
Pharmacist-improved outcomes for heart failure and mental health
Meanwhile, a meta-analysis has found that pharmacists working with heart failure patients improve outcomes and suggests more needs to be done to include the profession in multidisciplinary teams. Pharmacists also improve outcomes for mental health patients, an advanced clinical pharmacist at NHS Lanarkshire told the Royal Pharmaceutical Society Scotland conference, sharing that since pharmacists took over medication reviews, patients were waiting less than 7 weeks from prescriber referral to their first medication review — down from the CAMHS team’s self-imposed target of 12 weeks.
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Prescribing for dementia and delirium
Data published by NHS England reveals a rise in dementia diagnoses — from 490,163 this time in 2024 to 506,549 people with a diagnosis in 2025. Jeremy Isaacs, national clinical director for dementia at NHS England, said a diagnosis was the “first step in supporting people”, while Kieran Winterburn, head of national influencing at Alzheimer’s Society, said: “An early and accurate diagnosis can unlock access to crucial care, support and treatment — helping people manage their symptoms and avoid reaching crisis point.” Pharmacists working in this area may be interested in a study published in Brain and Behaviour that collates evidence on medication risks in delirium in patients with and without dementia to support prescribing decision-making and patient safety.
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Cancer research and medicines pricing concerns
Exosomes from people with type 2 diabetes are linked to suppressed immune activity inside human breast tumours, which could help explain why current treatments, such as immunotherapy, don’t work as well in patients with diabetes, a study published in Communications Biology suggests.
A phase three study published this week could help improve patient experience of cancer treatment, suggesting that toripalimab combined with induction chemotherapy and radiotherapy without concurrent cisplatin, vs standard therapy (with cisplatin), led to noninferior three-year failure-free survival (88.3% vs 87.6%) and lower incidence of all-grade vomiting (26.2% vs 59.8%).
Meanwhile, a preclinical study suggests that breast cancer drug tamoxifen encourages uterine cell growth and could be linked to an increased risk of developing uterine cancer — potentially impacting future treatment pathways.
Last week, we reported that the government and pharmaceutical industry representatives had been unable to reach an agreement on NHS branded medicines pricing, and at the weekend, the Sunday Times reported that cancer drug Trodelvy (sacituzumab govitecan; Gilead) would not be available on the NHS owing to its high cost. We’ll be keeping a close eye on what the ongoing medicines stand-off will mean for the future of high-cost drugs, such as cancer treatment, and the impact that pricing and supply will have on patients and clinicians.
