Pharmacist-Led Interventions on Improving Outcomes in Patients with Diabetes Mellitus: Evidence from the Literature

Evidence from the literature

  • Sini T Inasu Vinayaka Missions College of Pharmacy, Vinayaka Mission’s Research Foundation (Deemed University) Salem, Tamil Nadu- 636008, India
  • MV Kumudavalli Department of Pharmacy Practice, Ahalia School of Pharmacy, Palakkad, Kerala- 678557, India

Abstract

Diabetes mellitus is a rapidly growing major health problem world-wide. The management of type 2 diabetes mellitus is complex, requiring continuous medical care by health care professionals and considerable self-care efforts by patients. A collaborative and integrated team approach in which pharmacists can play a pivotal role should be sought when managing patients with diabetes. Pharmacist-led care programs have been shown to help patients with diabetes succeed in achieving treatment goals and improving outcomes. Hence, the aim of this narrative review is to address and summarize the effectiveness of pharmacist interventions in the management of diabetic patients. A comprehensive literature search was conducted in PubMed/Medline, Scopus, web of Science and the Cochrane Library were searched from the date of database inception to June 2019. All randomized controlled trials evaluating the effectiveness of pharmacist-based interventions on diabetic patients in comparison with usual care were included in study. Outcomes of interest included short-term and long-term measures such as glycated haemoglobin (HbA1c), and secondary outcomes were blood glucose level, blood pressure (BP), lipid profile, body mass index (BMI), 10-year coronary heart disease (CHD) risk, medication adherence, health related quality of life (HRQoL), and economic outcomes. Twenty-five studies were included in this systematic study. They were heterogeneous in terms of interventions, participants, settings and outcomes. Pharmacist-led self-management interventions included education on diabetes and its complications, medication adherence, lifestyle and education of self-management skills. Few studies even focussed on patients need through a tailored intervention. We found that those who received the pharmacist care had a statistically significant improvement in HbA1C, blood pressure, lipid profile, health-related quality of life, and CHD risk. These results underline the added value of pharmacists in patient-related care.  Hence this review supports the involvement of pharmacists as a member of health- care teams in managing diabetic patients at diverse settings worldwide.


Keywords: diabetes, self-management, HbA1C, pharmaceutical care, randomized controlled trial

Keywords: diabetes, self-management, HbA1C, pharmaceutical care, randomized controlled trial

Downloads

Download data is not yet available.

Author Biographies

Sini T Inasu, Vinayaka Missions College of Pharmacy, Vinayaka Mission’s Research Foundation (Deemed University) Salem, Tamil Nadu- 636008, India

Vinayaka Missions College of Pharmacy, Vinayaka Mission’s Research Foundation (Deemed University) Salem, Tamil Nadu- 636008, India

MV Kumudavalli, Department of Pharmacy Practice, Ahalia School of Pharmacy, Palakkad, Kerala- 678557, India

Professor, Department of Pharmacy Practice, Ahalia School of Pharmacy, Palakkad, Kerala- 678557, India

References

1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium: International Diabetes Federation. 2019. Available at: http://www. idf.org/diabetesatlas. Accessed May 14, 2020.
2. Benedict AW, Spence MM, Sie JL et al. Evaluation of a Pharmacist-Managed diabetes program in a primary care setting within an integrated health care system. J Manag Care Spec Pharm.2018; 24(2):114-22.
3. Wu Y, Ding Y, Tanaka Y, Zhang W et al. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. Int J Med Sci. 2014; 11(11):1185-200.
4. Siaw M Y L, Malone D C, Ko Y et al. Cost-effectiveness of multidisciplinary collaborative care versus usual care in the management of high-risk patients with diabetes in Singapore: Short term results from a randomized controlled trial. J Clin Pharm Ther. 2018;1-9.
5. Marx MC, Dahal A, Jennings B et al. The effect of a diabetes collaborative care management program on clinical and Economic outcomes in patients with type 2 diabetes. J Manag Care Spec Pharm. 2015; 21(6):452-68.
6. Pousinho S, Margado M, Falcao A, Aves G. Pharmacist intervention in the management of type 2 diabetes mellitus: A systematic review of randomised controlled trials. J Manag Care Spec Pharm.2016; 22(5):493-515.
7. Eliasson B, Cederholm J, Nilsson P, Gudbjornsdottir S; Steering Committee of the Swedish National Diabetes Register. The gap between guidelines and reality: type 2 diabetes in a National Diabetes Register 1996-2003. Diabet Med. 2005; 22(10):1420-26.
8. Antoine SL, Pieper D, Mathes T et al. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials. BMC. 2014; 14:53.
9. Wubben DP, Vivian EM. Effects of pharmacist outpatients’ interventions on adults with diabetes mellitus: a systematic review. Pharmacotherapy.2008; 28:421-436.
10. Tapp H, Phillips SE, Waxman D, et al. Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic. J Am Board Fam Med.2012; 25:245-246.
11. American Diabetes Association. Standards of medical care in diabetes -2017.Diabetes Care. 2017; 40 (suppl 1): S1-S32.
12. Presley B, Groot W, Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: A Systematic review and meta- analysis. Research in Social and Administrative Pharmacy. 2019; 15:1057-1067.
13. McClean MT, McElnay JC, Andrews J. The importance of patients education and patient involvement in the treatment of diabetes. Pharm J. 2000; 265:108-10.
14. Grossman S. Management of type 2 diabetes mellitus in the elderly: role of the pharmacist in a multidisciplinary health care team. J Multidiscip Healthc.2011; 4:149-154.
15. van Eikenhorst L, Taxis K, van Dijk L, de Gier H. Pharmacist led self-management interventions to improve diabetes outcomes: a systematic literature review and meta-analysis. Front Pharmacol 2017; 8:891.
16. Hassali MA, Nazir SU, Saleem F, Masood I. Literature review: pharmacists’ interventions to improve control and management in type 2 diabetes mellitus. Altern Ther Health Med 2015; 21:28-35.
17. Iqbal MZ, Khan AH, Iqbal MS, Sulaiman SAS. A review of pharmacist-led interventions on diabetes outcomes: An observational analysis to explore diabetes care opportunities for pharmacists. J Pharm Bioall Sci. 2019; 11:299-309.
18. Rajpathak SN, Kumbhani DJ, Crandall J, Barzilai N, Alderman M, Ridker PM. Statin therapy and risk of developing type 2 diabetes: a meta-analysis. Diabetes Care 2009; 32:1924-9.
19. DeCoster VA. Challenges of type 2 diabetes sand role of health care social work: a neglected area of practice. Health Soc Work 2001; 26:26-37.
20. 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):240-47.
21. Ali M, Schifano F, Robinson P, et al. Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study. Diabet Med. 2012; 29(9):326-33.
22. Butt M., Mhd Ali A, Bakry MM. and 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: 40–48.
23. Cani CG, Lopes LS, Queiroz M, and 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. 2015; 70: 102–106.
24. 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.
25. 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): 801-12.
26. Doucette WR, Witry MJ, Farris KB, and McDonough RP. Community pharmacist–provided extended diabetes care. Ann. Pharm.2009; 43: 882–889.
27. 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.
28. 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):516-26.
29. Jameson JP, and Baty PJ. Pharmacist collaborative management of poorly controlled diabetes mellitus: a randomized controlled trial. Am. J. Manag. Care.2010; 16: 250–255.
30. Jahangard-Rafsanjani Z, Sarayani A, Nosrati M, Saadat N, Rashidian, Hadjibabaie,M, et al. Effect of a community pharmacist delivered diabetes support program for patients receiving specialty medical care: a randomized controlled trial. Diabet. Educ. 2015; 41: 127–135.
31. Korcegez EI, Sancar M, and 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. Manage. Care Special. Pharm. 2017; 23:573–582.
32. Kraemer DF, Kradjan WA, Bianco TM, Low JA. A randomized study to assess the impact of pharmacist counselling of employer-based health plan beneficiaries with diabetes: the EMPOWER study. J Pharm Pract. 2012; 25:169-79.
33. Kjeldsen LJ, Bjerrum L, Dam P, Larsen BO, Rossing C, Søndergaard B. Safe and effective use of medicines for patients with type 2 diabetes: a randomized controlled trial of two interventions delivered by local pharmacies. Res Social Adm Pharm. 2015; 11(1):47-62.
34. Lau BT, Ismail SZ, Ng SY, Mohmmad N. Impact of pharmacist led diabetes program on glycated haemoglobin and diabetes related hospitalizations in a district-level hospital: a pilot retrospective cohort study. Int J Adv Life Sci Res 2018; 1:26-36.
35. 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; 29:595-601.
36. Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, et al. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. J Clin Pharm Ther. 2011; 36:602-13.
37. Mourão AO, Ferreira WR, Martins MA, Reis AM, Carrillo MR, Guimarães AG, et al. Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial. Int J Clin Pharm. 2013; 35:79-86.
38. Nascimentoa 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; 12:120-8.
39. Samtia AM, Rasool MF, Ranjha NM, Usman F, Javed I. A multifactorial intervention to enhance adherence to medications and disease-related knowledge in type 2 diabetic patients in Southern Punjab, Pakistan. Trop J Pharm Res. 2013; 12:851-6.
40. Shao H, Chen G, Zhu C, Chen Y, Liu Y, He Y, et al. Effect of pharmaceutical care on clinical outcomes of outpatients with type 2 diabetes mellitus. Patient Prefer Adherence. 2017; 11:897-903.
41. Siaw MYL, Ko Y, Malone DC, Tsou KYK, Lew J, Foo D, et al. 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, 475–482.
42. Taveira TH, Friedmann PD, Cohen LB, Dooley AG, Khatana SA, Pirraglia PA, et al. Pharmacist-led group medical appointment model in type 2 diabetes. Diabetes Educ. 2010; 36:109-17.
43. Tourkmani AM, Hassali MA, Alharbi TJ, Alkhashan HI, Alobikan AH, Bakhiet AH, et al. Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetes. Patient Prefer. Adherence. 2016; 10:1709–1717.
44. 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):271-76.
45. Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, et al. Effect of mobile phone intervention for diabetes on glycaemic control: A meta-analysis. Diabet Med. 2011; 28:455–63.
46. Bukhsh A, Khan T M, Lee S W H, Lee L H, et al. Efficacy of Pharmacist-based Diabetes Educational interventions on clinical outcomes of adults with type 2 diabetes mellitus: A Network Meta-Analysis. Front. Pharmacol. 2018; 9:339.
47. Liew SM, Lee PY, Hanafi NS, Ng CJ, Wong SS, Chia YC, et al. Statins use is associated with poorer glycaemic control in a cohort of hypertensive patients with diabetes and without diabetes. Diabetol Metab Syndr 2014; 6:53.
48. Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375:735-42.
49. Pradhan A, Libby P. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention. Lancet 2012; 380:565-71.
50. 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):1837-47.
51. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340:c332.
Statistics
8 Views | 14 Downloads
How to Cite
1.
Inasu S, Kumudavalli M. Pharmacist-Led Interventions on Improving Outcomes in Patients with Diabetes Mellitus: Evidence from the Literature. JDDT [Internet]. 15Jul.2020 [cited 29Sep.2020];10(4):49-8. Available from: http://www.jddtonline.info/index.php/jddt/article/view/4195