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

Keywords: Diabetes Mellitus, Type 2, Pharmacists, Pharmacies, Pharmaceutical Services, Blood Glucose, Glycated Hemoglobin A, Quality of Life, Medication Adherence, Cost-Benefit Analysis, Systematic Reviews as Topic

Abstract

Background: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements.

Objective: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes.

Methods: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities.

Results: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable.

Conclusions: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.

Downloads

Download data is not yet available.

Author Biographies

Sarah Pousinho

 

 

 

Manuel Morgado

 

 

Ana I. Plácido

 

 

Amílcar Falcão

 

 

Gilberto Alves

 

 

References

Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88-98. https://doi.org/10.1038/nrendo.2017.151

American Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5-26. https://doi.org/10.2337/cd16-0067

Solli O, Stavem K, Kristiansen IS. Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health Qual Life Outcomes. 2010;8:18. Published 2010 Feb 4. https://doi.org/10.1186/1477-7525-8-18

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-412. https://doi.org/10.1136/bmj.321.7258.405

Jenssen TG, Tonstad S, Claudi T, Midthjell K, Cooper J. The gap between guidelines and practice in the treatment of type 2 diabetes A nationwide survey in Norway. Diabetes Res Clin Pract. 2008;80(2):314-320. https://doi.org/10.1016/j.diabres.2007.12.025

Kemp TM, Barr EL, Zimmet PZ, Cameron AJ, Welborn TA, Colagiuri S, Phillips P, Shaw JE. Glucose, lipid, and blood pressure control in Australian adults with type 2 diabetes: the 1999-2000 AusDiab. Diabetes Care. 2005;28(6):1490-1492. https://doi.org/10.2337/diacare.28.6.1490

Orozco-Beltrán D, Gil-Guillen VF, Quirce F, Navarro-Perez J, Pineda M, Gomez-de-la-Cámara A, Pita S, Diez-Espino J, Mateos J, Merino J, Serrano-Rios M; Collaborative Diabetes Study Investigators. Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain. Int J Clin Pract. 2007;61(6):909-915. https://doi.org/10.1111/j.1742-1241.2007.01367.x

Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1-9. https://doi.org/10.1016/j.diabres.2011.02.002

Debussche X. Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review. Diabetes Metab Syndr Obes. 2014;7:357-367. https://doi.org/10.2147/dmso.s36369

American College of Clinical Pharmacy, Hume AL, Kirwin J, Bieber HL, Couchenour RL, Hall DL, Kennedy AK, LaPointe NM, Burkhardt CD, Schilli K, Seaton T, Trujillo J, Wiggins B. Improving care transitions: current practice and future opportunities for pharmacists. Pharmacotherapy. 2012;32(11):e326-e337. https://doi.org/10.1002/phar.1215

Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.

Nichols-English GJ, Provost M, Koompalum D, Chen H, Athar M. Strategies for pharmacists in the implementation of diabetes mellitus management programs - new roles in primary and collaborative care. Disease management & health outcomes 2002;12(9):783-803. https://doi.org/10.2165/00115677-200210120-00005

Antoine SL, Pieper D, Mathes T, Eikermann M. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials. BMC Endocr Disord. 2014;14:53. https://doi.org/10.1186/1472-6823-14-53

Omran D, Guirguis LM, Simpson SH. Systematic review of pharmacist interventions to improve adherence to oral antidiabetic medications in people with type 2 diabetes Canadian journal of diabetes 2012;36(5):292-299. https://doi.org/10.1016/j.jcjd.2012.07.002

Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care. 2012;35(12):2706-2717. https://doi.org/10.2337/dc12-0369

Wubben DP, Vivian EM. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review. Pharmacotherapy. 2008;28(4):421-436. https://doi.org/10.1592/phco.28.4.421

Fazel MT, Bagalagel A, Lee JK, Martin JR, Slack MK. Impact of Diabetes Care by Pharmacists as Part of Health Care Team in Ambulatory Settings: A Systematic Review and Meta-analysis. Ann Pharmacother. 2017;51(10):890-907. https://doi.org/10.1177/1060028017711454

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928

Adams RP, Barton G, Bhattacharya D, Grassby PF, Holland R, Howe A, Norris N, Shepstone L, Wright DJ. Supervised pharmacy student-led medication review in primary care for patients with type 2 diabetes: a randomised controlled pilot study. BMJ Open. 2015;5(11):e009246. https://doi.org/10.1136/bmjopen-2015-009246

Pimazoni-Netto A, Zanella MT. Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia. Diabetes Technol Ther. 2014;16(11):768-770. https://doi.org/10.1089/dia.2014.0092

Adibe MO, Ukwe CV, Aguwa CN. The Impact of Pharmaceutical Care Intervention on the Quality of Life of Nigerian Patients Receiving Treatment for Type 2 Diabetes. Value Health Reg Issues. 2013;2(2):240-247. https://doi.org/10.1016/j.vhri.2013.06.007

Aguiar PM, da Silva CHP, Chiann C, Dórea EL, Lyra DP Jr, Storpirtis S. Pharmacist-physician collaborative care model for patients with uncontrolled type 2 diabetes in Brazil: results from a randomized controlled trial. J Eval Clin Pract. 2018;24(1):22-30. https://doi.org/10.1111/jep.12606

Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC. Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. Br J Clin Pharmacol. 2009;67(5):547-557. https://doi.org/10.1111/j.1365-2125.2009.03391.x

Butt M, Mhd Ali A, Bakry MM, Mustafa N. Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study. Saudi Pharm J. 2016;24(1):40-48. https://doi.org/10.1016/j.jsps.2015.02.023

Cani CG, Lopes Lda S, Queiroz M, Nery M. Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital. Clinics (Sao Paulo). 2015;70(2):102-106. https://doi.org/10.6061/clinics/2015(02)06

Chan CW, Siu SC, Wong CK, Lee VW. A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes. J Cardiovasc Pharmacol Ther. 2012;17(1):57-64. https://doi.org/10.1177/1074248410396216

Chen JH, Ou HT, Lin TC, Lai EC, Kao YH. Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus: a randomized controlled trial. Int J Clin Pharm. 2016;38(1):88-95. https://doi.org/10.1007/s11096-015-0210-4

Choe HM, Mitrovich S, Dubay D, Hayward RA, Krein SL, Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care. 2005;11(4):253-260.

Chung WW, Chua SS, Lai PS, Chan SP. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes. Patient Prefer Adherence. 2014;8:1185-1194. https://doi.org/10.2147/ppa.s66619

Cohen LB, Taveira TH, Khatana SA, Dooley AG, Pirraglia PA, Wu WC. Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ. 2011;37(6):801-812. https://doi.org/10.1177/0145721711423980

Farsaei S, Sabzghabaee AM, Zargarzadeh AH, Amini M. Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: a randomized controlled trial. J Res Med Sci. 2011;16(1):43-49.

George A, Jewel V, Manohar M, Kumar S, Muneerudeen J. Impact of patient counselling on knowledge, attitude, practices of patients with type 2 diabetes mellitus at a tertiary care teaching hospital. Asian J Pharm Clin Res. 2017;10(5):17637. http://doi.org/10.22159/ajpcr.2017.v10i5.17637

Ghosh S, Rajvanshi A, Kishun S. Assessment the influence of patient counseling on quality of life in type-II diabetes mellitus patients. Int J Pharma Bio Sci. 2010;3:6.

Goruntla N, Mallela V, Nayakanti D. Impact of Pharmacist-directed Counseling and Message Reminder Services on Medication Adherence and Clinical Outcomes in Type 2 Diabetes Mellitus. J Pharm Bioallied Sci. 2019;11(1):69-76. https://doi.org/10.4103/jpbs.jpbs_211_18

Grant RW, Devita NG, Singer DE, Meigs JB. Improving adherence and reducing medication discrepancies in patients with diabetes. Ann Pharmacother. 2003;37(7-8):962-969. https://doi.org/10.1345/aph.1c452

Jaber LA, Halapy H, Fernet M, Tummalapalli S, Diwakaran H. Evaluation of a pharmaceutical care model on diabetes management. Ann Pharmacother. 1996;30(3):238-243. https://doi.org/10.1177/106002809603000305

Jacobs M, Sherry PS, Taylor LM, Amato M, Tataronis GR, Cushing G. Pharmacist Assisted Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study. J Am Pharm Assoc (2003). 2012;52(5):613-621. https://doi.org/10.1331/japha.2012.10183

Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Pharm. 2012;18(7):516-526. https://doi.org/10.18553/jmcp.2012.18.7.516

Javaid Z, Imtiaz U, Khalid I, Saeed H, Khan RQ, Islam M, Saleem Z, Sohail MF, Danish Z, Batool F, Anwer N. A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan. BMC Health Serv Res. 2019;19(1):409. Published 2019 Jun 24. https://doi.org/10.1186/s12913-019-4274-z

Korcegez EI, Sancar M, Demirkan K. Effect of a Pharmacist-Led Program on Improving Outcomes in Patients with Type 2 Diabetes Mellitus from Northern Cyprus: A Randomized Controlled Trial. J Manag Care Spec Pharm. 2017;23(5):573-582. https://doi.org/10.18553/jmcp.2017.23.5.573

Lim PC, Lim K, Embee ZC, Hassali MA, Thiagarajan A, Khan TM. Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia. Pak J Pharm Sci. 2016;29(2):595-601.

Mahwi T, Obied K. Role of the pharmaceutical care in the management of patients with type 2 diabetes mellitus. Int J Pharm Sci Res. 2013;4(4): 1363-1369. http://doi.org/10.13040/IJPSR.0975-8232.4(4).1363-69

Maidana GM, Mastroianni PC, Vera Z, Samaniego L, Acosta P, Lugo GB. Impact of pharmaceutical care in clinical outcomes and quality of life of patients with type 2 diabetes mellitus Pharm Care Esp 2016;18(3):107-121.

Mourão AO, Ferreira WR, Martins MA, Reis AM, Carrillo MR, Guimarães AG, Ev LS. Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial. Int J Clin Pharm. 2013;35(1):79-86. https://doi.org/10.1007/s11096-012-9710-7

Nascimento T, Braz N, Gomes E, Fernandez-Arche A, De La Puerta R. Self-care Improvement After a Pharmaceutical Intervention in Elderly Type 2 Diabetic Patients. Curr Diabetes Rev. 2015;12(2):120-128. https://doi.org/10.2174/1573399811666150722130232

Odegard PS, Goo A, Hummel J, Williams KL, Gray SL. Caring for poorly controlled diabetes mellitus: a randomized pharmacist intervention. Ann Pharmacother. 2005;39(3):433-440. https://doi.org/10.1345/aph.1e438

Plaster CP, Melo DT, Boldt V, Cassaro KO, Lessa FC, Boëchat GA, Bissoli NS, Andrade TU. Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up. Braz J Pharm Sci. 2012;48(3):435-446. https://doi.org/10.1590/S1984-82502012000300010

Ramanath K, Santhosh Y. Impact of clinical pharmacist provided patient education on QOL outcome in type II diabetes mellitus in rural population. Asian J Pharm Clin Res. 2011;4(4):15-20.

Scott DM, Boyd ST, Stephan M, Augustine SC, Reardon TP. Outcomes of pharmacist-managed diabetes care services in a community health center. Am J Health Syst Pharm. 2006;63(21):2116-2122. https://doi.org/10.2146/ajhp060040

Shao H, Chen G, Zhu C, Chen Y, Liu Y, He Y, Jin H. Effect of pharmaceutical care on clinical outcomes of outpatients with type 2 diabetes mellitus. Patient Prefer Adherence. 2017;11:897-903. https://doi.org/10.2147/ppa.s92533

Siaw MYL, Ko Y, Malone DC, Tsou KYK, Lew YJ, Foo D, Tan E, Chan SC, Chia A, Sinaram SS, Goh KC, Lee JY. Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial. J Clin Pharm Ther. 2017;42(4):475-482. https://doi.org/10.1111/jcpt.12536

Simpson SH, Majumdar SR, Tsuyuki RT, Lewanczuk RZ, Spooner R, Johnson JA. Effect of adding pharmacists to primary care teams on blood pressure control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Care. 2011;34(1):20-26. https://doi.org/10.2337/dc10-1294

Sriram S, Chack LE, Ramasamy R, Ghasemi A, Ravi TK, Sabzghabaee AM. Impact of pharmaceutical care on quality of life in patients with type 2 diabetes mellitus. J Res Med Sci. 2011;16 Suppl 1(Suppl1):S412-S418.

Suppapitiporn S, Chindavijak B, Onsanit S. Effect of diabetes drug counseling by pharmacist, diabetic disease booklet and special medication containers on glycemic control of type 2 diabetes mellitus: a randomized controlled trial. J Med Assoc Thai. 2005;88 Suppl 4:S134-S141.

Wishah RA, Al-Khawaldeh OA, Albsoul AM. Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: Randomized controlled trial. Diabetes Metab Syndr. 2015;9(4):271-276. https://doi.org/10.1016/j.dsx.2014.09.001

Withidpanyawong U, Lerkiatbundit S, Saengcharoen W. Family-based intervention by pharmacists for type 2 diabetes: A randomised controlled trial. Patient Educ Couns. 2019;102(1):85-92. https://doi.org/10.1016/j.pec.2018.08.015

Wu WC, Taveira TH, Jeffery S, Jiang L, Tokuda L, Musial J, Cohen LB, Uhrle F. Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial. PLoS One. 2018;13(4):e0195898. https://doi.org/10.1371/journal.pone.0195898

Adibe MO, Aguwa CN, Ukwe CV. Cost-Utility Analysis of Pharmaceutical Care Intervention Versus Usual Care in Management of Nigerian Patients with Type 2 Diabetes. Value Health Reg Issues. 2013;2(2):189-198. https://doi.org/10.1016/j.vhri.2013.06.009

Omran D, Majumdar SR, Johnson JA, Tsuyuki RT, Lewanczuk RZ, Guirguis LM, Makowsky M, Simpson SH. Pharmacists on primary care teams: Effect on antihypertensive medication management in patients with type 2 diabetes. J Am Pharm Assoc (2003). 2015;55(3):265-268. https://doi.org/10.1331/japha.2015.14225

Simpson SH, Lier DA, Majumdar SR, Tsuyuki RT, Lewanczuk RZ, Spooner R, Johnson JA. Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial. Diabet Med. 2015;32(7):899-906. https://doi.org/10.1111/dme.12692

Pousinho S, Morgado M, Falcão A, Alves G. Pharmacist Interventions in the Management of Type 2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials. J Manag Care Spec Pharm. 2016;22(5):493-515. https://doi.org/10.18553/jmcp.2016.22.5.493

MacCallum L, Dolovich L. Follow-up in community pharmacy should be routine, not extraordinary. Can Pharm J (Ott). 2018;151(2):79-81. https://doi.org/10.1177/1715163518756586

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837-853. https://doi.org/10.1016/S0140-6736(98)07019-6

Stevens RJ, Kothari V, Adler AI, Stratton IM; United Kingdom Prospective Diabetes Study (UKPDS) Group. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56) [published correction appears in Clin Sci (Lond) 2002 Jun;102(6):679]. Clin Sci (Lond). 2001;101(6):671-679.

Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837-1847. https://doi.org/10.1161/01.cir.97.18.1837

Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis. 1998;140(2):199-270. https://doi.org/10.1016/s0021-9150(98)90209-x

Gonzalez JS, Schneider HE, Wexler DJ, Psaros C, Delahanty LM, Cagliero E, Safren SA. Validity of medication adherence self-reports in adults with type 2 diabetes. Diabetes Care. 2013;36(4):831-837. https://doi.org/10.2337/dc12-0410

Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. https://doi.org/10.1056/nejmra050100

Kheir NM, van Mil JW, Shaw JP, Sheridan JL. Health-related quality of life measurement in pharmaceutical care. Targeting an outcome that matters. Pharm World Sci. 2004;26(3):125-128. https://doi.org/10.1023/b:phar.0000026811.37414.4f

Kozma CM, Reeder CE, Schulz RM. Economic, clinical, and humanistic outcomes: a planning model for pharmacoeconomic research. Clin Ther. 1993;15(6):1121-1120.

Published
2020-08-28
How to Cite
1.
Pousinho S, Morgado M, Plácido AI, Roque F, Falcão A, Alves G. Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review. Pharm Pract (Granada) [Internet]. 2020Aug.28 [cited 2020Sep.24];18(3):2000. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/2000
Section
Original Research