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 [email protected].
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
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