Candis M. Morello, PharmD, CDE

Research Interests

• Exploring clinical outcomes in diabetes patients

• Director, Diabetes Intense Medical Management Clinic, VASDHS

Research Team with Jan Hirsch• DIMM Clinic Managers Team

• Ginger Lo, Class of 2018• Mandy Leung, Class of 2018• Jennifer Vu, Class of 2017• Carmen Truong, Class of 2017

• Clinical and Long Term Outcomes• Andrea Bechthold, Class of 2014• John Khoan, Class of 2016

• Patient Satisfaction Outcomes• Sandy Chong, Class of 2014

• Medication Adherence Outcomes• Crystal Zhou, Class of 2015

• Pharmacoeconomic Outcomes• David Ha, Class of 2012• Christine Cadiz, Class of 2012• Mark Bounthavong, PharmD• Andrew Zimmerman, Class of 2015

• Medication & Comorbid Complexity• John Khoan, Class of 2016• Taylor Rotunno, Class of 2016

Clinical Care: Finding the Best Combo with the Patient

Stomach: GLP-1 analogs and

amylin analog (slows gastric emptying)

Brain: GLP-1 analogs, amylin analog (satiety)

Pancreas/Beta cells: SFU, Glinides (insulin secretion)

GLP-1 analogs, DPP-4 Inh (glucose-dependent insulin

secretion)

Pancreas/Alpha cells: GLP-1 analogs, amylin analog , DPP-4 Inh ( postprandial glucagon secretion)

Gut:GLP-1 agonist, analog

Mouth: GLP-1 analogs, amylin analog (reduced caloric intake)

Muscles and tissues: TZD, Metformin (insulin sensitivity), Insulin (peripheral glucose uptake)

Gut:AGI /BAS (delays CHO breakdown/absorption)

Liver: Metformin, Insulin, GLP-1

analogs, amylin analog, DPP-4 Inh (↓ Hepatic

glucose output)output)

Image developed from images at: www.topnews.in/healthcare/node?page=12, www.jamesgillespiesps.ik.org, www.beyondbiology.org/beyondbiology.org/index on 6/18/10.Revised 6/9/14 CMMorello

Kidneys:SGLT-2 inh (increases glucose urinary output)

CARDIOVASCULARDISEASE

CVA

MIHTN

LIPIDS

MENTAL HEALTHDISORDERS

BPH

MEDICATIONADHERENCE

COOKING GROCERIES

LIVINGSITUATION

CULTURAL BELIEFS& PREFERENCES

PHYSICAL ACTIVITY

ACCESSTO CARE

READINESSTO CHANGE

USE OF TOBACCO, EtOH, ILLICIT DRUGS

LEGAL ISSUES

QUALITY & QUANITITY OF FOOD

WEIGHTGLYCEMICCONTROL

HYPOGLYCEMIA

NOCTURIA, BLURRY

VISION, LOW ENERGY

ELECTROLYES

SODIUMINTAKE

RENAL STATUS

NEPHROPATHY MICROALBUMINERIA

RETINOPATHYFOOT CARE

PVD VISION CHANGES

AMPUTATIONSFUNGAL

INFECTIONS BACTERIALINFECTIONS

BLINDNESS

MOTIVATING FACTORS

FINANCES

PERSON WITHDIABETES

CLINICALCO-MORBIDITIES

SOCIOECONOMIC

AND BEHAVIORAL

COMPLICATIONSMTM Spider Web©

Adapted from Morello CM, Hirsch J, Lee KC. Navigating the complexity of patients through an innovative tool: The MTM Spider Web. JAPhA.2013; 53(5):530–538.

Use of the MTM Spider Web© is protected by U.S. copyright laws. Permission for use is required by primary author at andismorello@ucsd.edu.

DPN

MEDICATION MONITORING,

ADRS

MEDICATION COMPLEXITY

Individualized Clinical Care

Proposed Collaborations with SSPPS Faculty

General

• Diabetes treatments• Diabetes prevention• Inflammatory impact on

diabetes• Medication therapy

management• Medication complexity• Pharmacoeconomic impact• Geriatrics

Associated Conditions

• Cardiovascular• Lipids• Hypertension• Neuropathy• Retinopathy• Nephropathy• Wound healing• Depression• Hypothyroidism