Effective Interventions for Diabetes Patients by Community Pharmacists: A Meta-analysis of Pharmaceutical Care Components

Abstract

Our meta-analysis suggests that community pharmacist-led interventions can improve glycemic control in patients with type 1 and 2 diabetes. The most effective intervention components were patient centered and interdisciplinary. Pharmaceutical care interventions should, therefore, include the following components: sending feedback to the physician, setting individual goals, reviewing medication, and assessing patients' health beliefs and medication knowledge.

Pharmaceutical care-based interventions in type 2 diabetes mellitus : a systematic review and meta-analysis of randomized clinical trials

“…(34) Clear description of pharmaceutical care provided to participants in the Intervention Group was seldom given and few studies included SDSCA in the educational key component. Hence, statistical analysis per specific key component could not be performed, supporting results reported by Deters et al, (42) Overall, studies included in this meta-analysis reported that pharmacists involved in clinical trials were pharmacotherapy specialists and had been trained in diabetes education. However, data regarding training duration (hours) and healthcare professionals in charge were not always provided.…”

“…Deters et al, (42) included six studies in a metaanalysis of 640 participants in randomized clinical trials…”

“…Mean HbA1c difference of -0.66% (95%CI: -0.86; -0.45) and non-significant heterogeneity (I 2 =7.9%; p=0.3659) were reported. Deters et al, (42) also considered the meta-analytic effect of pharmacist interventions and evaluated mean HbA1c differences associated with drug-related problems/medication review (-0.79%) and feedback to medical team (-0.81%), and determined the impact of each intervention on the educational component: diabetes-related complications (-0.60%); knowledge about medications (-0.74%); diet, physical exercise and smoking cessation (-0.66%); self-monitoring of blood glucose analysis (-0.74%); definition of individual targets (-0.81%); adherence (-0.60%) and knowledge about diabetes (-0.54%). This study did not include meta-analysis per intervention, since not all clinical trials selected provided detailed description of components, such as number of patients submitted to a given intervention (educational interventions in particular).…”

“…(23) to investigate potential causes of high heterogeneity between studies. Given the small number of studies (less than ten), meta-regression was not performed; rather, subgroup analysis was repeated using the random effect model according to trial characteristics (participants with baseline HbA1c levels <9%; (27,32,34,36,37) interventions such as drug-related problems (27,32,34,37,40) and medication review; (28,29) frequent interventions -monthly or every 2 months; (21,26,29,30,32,35,40,42) outpatient settings (21,26,27,(30)(31)(32)(33)(34)(35) and community pharmacy; (29,37) ) per sex (i.e., studies with larger proportion of males (29,34,41,42) versus studies with larger proportion of females). (21,27,28,32,37,39) All analyses revealed high and significant heterogeneity (I 2 >98%; p<0.001).…”

The role of community pharmacists and their position in the delivery of diabetes care: an update for medical professionals

“…Despite varied settings, healthcare models and population groups, several systematic reviews have demonstrated the favourable impact community pharmacy interventions have on both clinical and patient-related outcomes (online supplementary table 2). 27–35…”