Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Pousinho, Sarah; Morgado, Manuel; Plácido, Ana I.; Roque, Fátima; Falcão, Amı́lcar; Alves, Gilberto

doi:10.18549/pharmpract.2020.3.2000

Cited by 16 publications

(20 citation statements)

References 62 publications

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“…In addition, our study reveals improvement in glycaemia in the intervention cohort, which may partly be linked to improved adherence to recommended therapies in the cohort compared to the control group. Though, the average HbA1c value in our study is above the American Diabetes Association (ADA) recommended target of < 7.0% [ 42 ], however, significant reduction (0.9%) in the average HbA1c from 8.7 ± 1.5% (baseline) to 7.8 ± 2.0% (6-month post-baseline) in the intervention group is consistent with previous studies in most developed and some developing countries [ 30 , 32 , 33 ]. Kiel et al in an observational prospective study to demonstrate the pharmacist’s impact on clinical outcomes in a diabetes disease management program showed an HbA1c reduction of 1.6% [ 53 ].…”

Section: Discussionsupporting

confidence: 91%

“…The challenge of treatment non-adherence among these patients may perhaps be averted if patients are adequately counseled on the necessity for optimal commitment to prescribed therapies, while non-adherent behaviours appropriately resolved [27][28][29][30]. Studies in many developed countries have reported improvement in medication adherence and clinical outcomes in pharmacist-conducted medication management among patients with diabetes [29,[31][32][33]. Also, it has been shown that a high level of medication adherence is associated with lower disease-related medical costs [12,34].…”

Section: Introductionmentioning

confidence: 99%

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Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria

Ipingbemi

Erhun

Adisa

2021

BMC Health Serv Res

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Background Non-adherence to recommended therapy remains a challenge to achieving optimal clinical outcome with resultant economic implications. Objective To evaluate the effect of a pharmacist-led intervention on treatment non-adherence and direct costs of management among patients with type 2 diabetes (T2D). Method A quasi-experimental study among 201-patients with T2D recruited from two-tertiary healthcare facilities in southwestern Nigeria using semi-structured interview. Patients were assigned into control (HbA1c < 7%, n = 95) and intervention (HbA1c ≥ 7%, n = 106) groups. Baseline questionnaire comprised modified 4-item Medication Adherence Questions (MAQ), Perceived Dietary Adherence Questionnaire (PDAQ) and International Physical Activity Questionnaire, to assess participants’ adherence to medications, diet and physical activity, respectively. Post-baseline, participants were followed-up for 6-month with patient-specific educational intervention provided to resolve adherence discrepancies in the intervention group only, while control group continued to receive usual care. Subsequently, direct costs of management for 6-month pre-baseline and 6-month post-baseline were estimated for both groups. Data were summarized using descriptive statistics. Chi-square, McNemar and paired t-test were used to evaluate categorical and continuous variables at p < 0.05. Results Mean age was 62.9 ± 11.6 years, and 160(79.6%) were females. Glycated haemoglobin (HbA1c) was 6.1 ± 0.6% (baseline) and 6.1 ± 0.8% at 6-month post-baseline (p = 0.094) for control group, and 8.7 ± 1.5% (baseline) versus 7.8 ± 2.0% (6-month), p < 0.001, for the intervention. Post-baseline, response to MAQ items 1 (p = 0.017) and 2 (p < 0.001) improved significantly for the intervention. PDAQ score increased significantly from 51.8 ± 8.8 at baseline to 56.5 ± 3.9 at 6-month (p < 0.001) for intervention, and from 56.3 ± 4.0 to 56.5 ± 3.9 (p = 0.094) for the control group. Physical activity increased from 775.2 ± 700.5 Metabolic Equivalent Task (MET) to 829.3 ± 695.5MET(p < 0.001) and from 901.4 ± 743.5MET to 911.7 ± 752.6MET (p = 0.327) for intervention and control groups, respectively. Direct costs of management per patient increased from USD 327.3 ± 114.4 to USD 333.0 ± 118.4 (p = 0.449) for the intervention, while it decreased from USD 290.1 ± 116.97 to USD289.1 ± 120.0 (p = 0.89) for control group, at baseline and 6-month post-baseline, respectively. Conclusion Pharmacist-led intervention enhanced adherence to recommended medications, diet and physical activity among the intervention patients, with a corresponding significant improvement in glycaemic outcome and an insignificant increase in direct costs of management. There is a need for active engagement of pharmacists in management of patients with diabetes in clinical practice. Trial registration ClinicalTrials.gov identifier: NCT04712916. Retrospectively-registered.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria

Ipingbemi

Erhun

Adisa

2021

BMC Health Serv Res

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“…4 Systematic reviews and meta-analysis of randomised controlled trials have demonstrated the effects of pharmacist-led care in patients with T2DM, but majority of these studies were conducted in high income countries (HICs) and only complimented by few from LMICs. [4][5][6][7][8][9][10][11][12] Literature search identified four published randomised-controlled trials among patients with DM in Nigeria within the last decade. [13][14][15][16][17] None of the study was done in the northern part of the country.…”

Section: Introductionmentioning

confidence: 99%

Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

David¹,

Soremekun²,

Abah³

et al. 2021

Pharm Pract (Granada)

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Background: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. Objective: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes Methods: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. Conclusions: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

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“…Evidence regarding the involvement of pharmacists in the chronic management of type 2 diabetic patients is limited and heterogeneous, albeit positive. In general, in studies where pharmacists were involved in the diabetes care team, a significant improvement in therapeutic outcomes, and a reduction in hospitalizations and consumption of resources were observed [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. These effects are more evident when prescription abilities are ascribed to the pharmacist (an activity not allowed by Italian law).…”

Section: Discussionmentioning

confidence: 99%

A New Case Manager for Diabetic Patients: A Pilot Observational Study of the Role of Community Pharmacists and Pharmacy Services in the Case Management of Diabetic Patients

Regina¹,

Pandolfi²,

Stabile³

et al. 2020

Pharmacy

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The adherence of type 2 diabetes mellitus (DM2) patients with an individual care plan (ICP) is often not satisfactory, nor does it allow for a significant improvement in outcome, because of poor accessibility to services, poor integration of pathway articulations, poor reconciliation with the patient’s life, or the lack of a constant reference person. The purpose of this study was to evaluate the contribution of community pharmacists and pharmacy services in improving adherence with periodic controls in DM2. The study was conducted at a rural pharmacy. A sample of 40 patients was calculated with respect to a historical cohort and subsequently enrolled. Clinical and personal data were collected in an electronic case report form. Pharmacists acting as a case manager followed patients carrying out their ICP developed by an attending physician. Some of the activities foreseen by the ICP, such as electrocardiogram, fundus examination, and self-analysis of blood and urine, were carried out directly in the pharmacy by the pharmacist through the use of telemedicine services and point of care units. Activities that could not be performed in the pharmacy were booked by the pharmacist at the accredited units. Examination results were electronically reported by the pharmacist to the attending physician. The primary endpoint was the variation in patient adherence with the ICP compared to a historical cohort. Secondary endpoints were variation in waiting time for the examinations, mean percentage change in glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL) cholesterol levels and blood pressure, impact on healthcare-related costs, and perceived quality of care. Adherence to the ICP significantly increased. Waiting times were reduced and clinical outcomes improved with conceivable effects on costs. Patients appreciated the easier access to services. Community pharmacists and pharmacy services represent ideal actors and context that, integrated in the care network, can really favor ICP adherence and obtain daily morbidity reduction and cost savings through proper disease control and an early diagnosis of complications.

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Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Cited by 16 publications

References 62 publications

Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria

Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria

Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

A New Case Manager for Diabetic Patients: A Pilot Observational Study of the Role of Community Pharmacists and Pharmacy Services in the Case Management of Diabetic Patients

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