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Background and Objective: According to the guidelines for diabetic care in Gotland, SGLT2-inhibitors and GLP-1-analogues are recommended as an add-on treatment for when metformin in monotherapy, exercise and diet recommendations are insufficient. The aim of this study was to gain a better understanding of the effect of SGLT2-inhibitors and GLP-1-analogues on HbA1c and weight changes in patients with type II diabetes in Gotland. In addition, an overview of respective antidiabetics prescriptions in patients from Wisby Söder Health Center was performed. Study design: A retrospective quantitative study with data from three health centers in Gotland. The study population included diabetes type II patients who were prescribed SGLT-inhibitors or GLP-1-analogues during the period 2018-06-30 to 2020-06-30. This study collected data from Wisby Söder Health Center which further was used for the compilation of data from two previous student projects performed at Visby Norr and Visborg Health Center. Results were presented descriptively, a linear regression-analysis and ANOVA-test was performed. Setting: The study was conducted at Visborg, Visby Norr and Wisby Söder Health Center. Main outcome measures: The primary outcome was the change in HbA1c and weight changes as a secondary outcome. Another objective was to identify the proportion of patients with insufficient treatment defined as <10 mmol/mol HbA1c-reduction with either drug.  Results: In total, 134 patients with SGLT2-inhibitors and 182 patients with GLP-1-analogues were included. The mean HbA1c-reduction for SGLT2-inhibitor was 11 mmol/mol (±13,5 95% KI 6,9-11,2) and for GLP-1-analogues 12 mmol/mol (±14,5 95% KI: 6,9-11,1). For each drug the mean weight reduction was 3 kg (±3). There was no correlation between age and HbA1c-changes.   Conclusion: In conclusion, similar HbA1c and weight reductions were achieved with the respective drugs as in previous studies. However only about 50% of the population achieved a HbA1c-decrease with >10 mmol/mol. This indicates that further measures might need to be taken to optimize diabetes care in Gotland.

Introduction: Single inhaler triple therapy (SITT) is used as maintenance therapy in servereCOPD. SITT is available as dry-powder inhalers (DPIs) and pressured metered-dose inhalers(pMDIs). pMDIs have a more harmful impact on the climate compared to DPIs. Aim: To map changes in the prescription of SITT in Sweden and to compare regionaldifferences regarding the climate impact of the treatments. Methods: A mapping of recommended SITT DPIs (ATC-code: R03AL08) and pMDIs (R03AL09,R03AL11) in all 21 regions. Changes in SITT prescriptions between 2018 and 2022 were retrieved from the national statistical database and used for the climate impact calculations.The regional drug committees were interviewed to discuss factors influencing theprescription of inhalers. Results: Ninety percent of the regions (n=19/21) recommended DPI as the first choice SITT. The use of pMDIs increased from 0.6 to 3.3 patients per 1,000 inhabitants and DPIs from 0.3to 2.2 patients per 1,000 inhabitants during the same period. The climate impact from SITT was significantly higher in 2022 than in 2018. The climate impact for DPIs increased from 9,370 kg CO2e in 2018 to 84,297 kg CO2e in 2022. The climate impact for pMDIs increased from 291,630 kg CO2e in 2018 to 2,765,651 kg CO2e in 2022. Increased recognition of SITT and annual treatment recommendation updates were factors influencing the SITT prescriptions found in the interviews.Conclusion: The SITT use in Sweden has increased since 2018. DPIs are widelyrecommended but pMDIs are more common. There are large regional differences in theprescription and climate impact, and most of the climate impact originates from the pMDIs. Follow-up of the SITT prescriptions at a regional level is proposed to reduce the climateimpact.

<p dir="ltr">Pharmaceutical manufacturing of solid oral dosage forms is undergoing a significant evolution with the introduction of continuous manufacturing and advanced manufacturing technologies such as three-dimensional printing (3DP). Pharmaceutical manufacturing requires new approaches to ensure the quality of excipients and new ways to design and formulate advanced solid oral dosage forms. One example of a raw material that has quality issues is magnesium stearate, the most commonly used excipient in solid oral dosage forms. The complicated physicochemical nature of magnesium stearate introduces variability to the performance of tablet lubrication and dissolution. The lack of understanding on this variability can cause product loss or failure of quality assessments. In addition, new manufacturing methods such as 3DP binder-jet printing of pharmaceuticals have poorly understood quality challenges that need to be explored.</p><p dir="ltr">The specific aims of this project are as follows: [1] To determine the susceptibility of the disordered form to form interconversion and disproportionation when used to make a tablet. The comparison of lab synthesized samples to the more relevant forms that appear in commercial products such as the monohydrate and dihydrate forms of magnesium stearate are included. 13C labeled magnesium stearate of all forms will be prepared to determine which causes the greatest extent of disproportionation.</p><p dir="ltr">[2] To determine if a newly investigated form of magnesium stearate, named the disordered form, is viable for pharmaceutical use. The disordered form must minimize risk impacting dissolution while being an effective lubricant, thereby reducing batch and continuous manufacturing failures.</p><p dir="ltr">[3] To evaluate how 3DP printed tablet manufacturing methods impact critical quality attributes. This work will identify the importance of attributes such as weight; binder composition; excipients; compatible drugs; software; hardware change as a function of raw material attributes (API, powder character, and binder) and critical process parameters.</p>

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