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

Nogueira, Marcel; Otuyama, Leonardo Jun; Rocha, Priscilla Alves; Pinto, Vanusa Barbosa

doi:10.31744/einstein_journal/2020RW4686

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REVIEW • Einstein (São Paulo) 18 • 2020 • https://doi.org/10.31744/einstein_journal/2020RW4686 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus .

Methods

PubMed^®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis.

Results

Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I²>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042).

Conclusion

Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.

Diabetes mellitus, type 2; Pharmaceutical services; Pharmacy service, hospital; Pharmacists

Reference	Settings	Population	Characterization of the sample	Follow-up	Interval of intervention	Pharmacist interventions	Control	Clinical endpoint measures
Mahwi et al.⁽²¹⁾	Diabetes center in Iraq	Type 2 diabetics aged 30 to 80 years	n=65/65* Lost to follow-up: 3/4* Age: 52.0±7, 86/53.4±10.81^† Sex: 71.0%/67.2% female	3 months	Monthly	Adherence, drug-related problems	Standard care by medical team	HbA1c, fasting glucose and drug-related problems, adherence
Jarab et al.⁽²⁶⁾	Diabetes outpatient service of a teaching hospital in Jordan	Type 2 diabetics aged ≥18 years, HbA1c ≥7.5%	n=85/86* Lost to follow-up: 8/7* Age: 63.4±10.1/65.3±9.2^† Sex: 42.4%/44.2% female	6 months	8 weeks (follow-up telephone calls)	Patient education, drug-related problems, follow-up telephone calls, self-care	Standard care by medical and nursing teams	HbA1c, adherence, blood pressure, TC, HDL, LDL, TG, BMI, self-care (SDSCA)
Wishah et al.⁽²⁷⁾	Diabetes outpatient service of a teaching hospital in Jordan	Type 2 diabetics aged ≥18 years, HbA1c ≥6.5%, use of oral hypoglycemic agent	n=52/54* Lost to follow-up: 2/3* Age: 52.9±9.6/53.2±11.2^† Sex: 61.5%/51.9% female	6 months	Not informed	Patient education, drug- related problems, self-care	Standard care by medical and nursing teams	HbA1c, blood pressure, TC, HDL, LDL, TG, BMI, fasting glucose, self-care (SDSCA)
Chung et al.⁽²⁸⁾	Teaching hospital in Malaysia	Type 2 diabetics aged ≥21 and <75 years, HbA1c ≥8%, use of oral hypoglycemic agent	n=120/121* Lost to follow-up: NR Age: 59.7±9.5/58.5±8.3^† Sex: 58.3%/53.7% female	12 months	3 to 4 months with monthly follow-up telephone calls	Medication review, diabetes education	Usual pharmacy services	HbA1c, fasting glucose, adherence
Ali et al.⁽²⁹⁾	Community pharmacies in the United Kingdom	Type 2 diabetics aged ≥18 years, HbA1c ≥7%, use of oral hypoglycemic agent	n=25/23* Lost to follow-up: 2/0* Age: 66.4±12.7/66.8±10.2^† Sex: 43.5%/56.5% male	12 months	Monthly in the first 2 months, then every 3 months	Medication review, patient education, referral to other healthcare professionals	Standard care by medical and nursing teams and community pharmacies	HbA1c, fasting glucose, blood pressure, LDL, HDL, TG, BMI, DQoL, HRQoL, adherence, diabetes knowledge test (DKT), SIMS
Mourão et al.⁽³⁰⁾	Primary Care Units in Brazil	Type 2 diabetics aged ≥18 years, HbA1c ≥7%, post-prandial glucose ≥180mg/dL, use of oral hypoglycemic agent	n=65/64* Lost to follow-up: 12/9* Age: 60.0±10.2/61.3±9.9^† Sex: 68.0%/66.0% female	12 months	Monthly	Drug-related problems, diabetes education	Standard care	HbA1c, blood pressure, LDL, HDL, TG, BMI, drug-related problems
Chan et al.⁽³¹⁾	Diabetes clinic of a public hospital in Hong Kong	Type 2 diabetics aged ≥18 years, HbA1c ≥8%, polypharmacy, use of oral hypoglycemic agent	n=51/54* Lost to follow-up: 0/0* Age: 63.2±9,5/61.74±11.2^† Gender: 58.8%/51.9% male	9 months	Not reported	Patient education, drug related problems	Standard care by medical team	HbA1c, blood pressure, LDL, HDL, TG, BMI, adherence, cardiovascular risk, cost-effectiveness
Korcegez et al.⁽³²⁾	Diabetes outpatient service in a public hospital in Turkish Republic of Northern Cyprus	Type 2 diabetics diagnosed at least 6 months prior to the study, HbA1c >7% and use of oral hypoglycemic agent	n=75/77* Lost to follow-up: 4/3* Age: 61.80±10.38/62.22±9.54^† Sex: 77.3%/74.0% female	12 months	2 months	Patient education, drug-related problems, self-care	Standard care by medical and nursing teams	HbA1c, blood pressure, TC, HDL, LDL, TG, BMI, fasting glucose, abdominal circumference, self-care (SDSCA)
Siaw et al.⁽³³⁾	Four outpatient services in Singapore	Type 2 diabetics aged ≥21 years, HbA1c ≥7%, polypharmacy and multiple comorbidities	n=214/197* Lost to follow-up: 3/1* Age: 59.2±8.2/60.1±8.1^† Sex: 52.3%/60.9% male	6 months	4 to 6 weeks	Patient education, drug-related problems, insulin dose adjustment based on symptoms (SIGN algorithm), follow-up telephone calls	Standard care by medical team	HbA1c, systolic blood pressure, LDL, TG, quality of life (PAID), satisfaction with treatment (DTSQ), use of health services, economic analysis
Cani et al.⁽³⁴⁾	Diabetes outpatient service at a teaching hospital in São Paulo	Type 2 diabetics aged ≥45 years, HbA1c ≥ 8.0%, use of insulin	n=37/41* Lost to follow-up: 3/5* Age: 61.91±9.58/61.58±8.14^† Sex: 34.0%/36% male	6 months	Not informed	Patient education, drug-related problems, insulin administration technique	Standard care	HbA1c, knowledge about diabetes, knowledge about drugs, adherence, insulin administration technique, glucose monitoring, quality of life (QoL)
Aguiar et al.⁽³⁵⁾	University secondary care hospital in São Paulo	Type 2 diabetics diagnosed at least 6 months prior to the study, HbA1c ≥7%, aged between 40 and 79 years, use of oral antidiabetic agent	n=36/37* Lost to follow-up: 0/0* Age: 61.1.6±7.9/62.4±8.2^† Sex: 69.4%/64,9% female	12 months	2 to 6 months (depending on glucose levels) and follow-up telephone calls between visits	Patient education, drug- related problems, insulin administration technique, follow-up telephone calls	Standard care by medical and nursing teams	HbA1c, blood pressure, LDL, adherence
Chen et al.⁽³⁶⁾	Nantou Hospital, in Taiwan	Type 2 diabetics aged ≥65 years, with HbA1c ≥9%	n=50/50* Lost to follow-up: NR Age: 72.16±6.6/72.76±5.9^† Sex: 50%/50% male and female	6 months	Monthly follow-up telephone calls	Patient education, drug-related problems, insulin administration technique, referral to other professionals, follow-up telephone calls	Standard care	HbA1c, fasting glucose, percentage of hospitalizations, economic analysis
Jahangard-Rafsanjani et al.⁽³⁷⁾	Community pharmacy in Teheran, Iran	Type 2 diabetics with HbA1c >7% and use of oral hypoglycemic agent	n=51/50* Lost to follow-up: 6/10* Age: 57.6±8.3/55.9±8.7*^† Sex: 25%/26% female	5 months	Monthly	Patient education, drug- related problems, follow-up telephone calls, self-care	Standard care by medical team	HbA1c, BMI, blood pressure, adherence, self-care (SDSCA)
Xin et al.⁽³⁸⁾	Tongde Hospital, Hangzhou province, China	Type 2 diabetics aged ≥18 years, no use of insulin over the last 18 months	n=120/120* Lost to follow-up: 6/7* Age: 58.8±14.4/59.2±14.2^† Sex: 51.8%/50.4% male	12 months	Not informed	Patient education, insulin administration technique, follow-up telephone calls	Standard care by medical team	HbA1c, adherence
Shao et al.⁽³⁹⁾	University hospital in Nanjing province, China	Type 2 diabetics aged ≥18 years, HbA1c ≥7%, diagnosed 3 months before or earlier, and use of oral hypoglycemic agent	n=20/120* Lost to follow-up: 20/21* Age: 58.86±10.59/59.20±10.34^† Sex: 51%/475% male	6 months	2 months (in-person) and monthly follow-up telephone calls	Patient education, follow-up telephone calls	Standard care by medical team	HbA1c, adherence, blood pressure, TC, HDL, LDL, TG, BMI, fasting glucose

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[1] Corresponding author: Marcel Nogueira. Divisão de Farmácia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Avenida Doutor Enéas de Carvalho Aguiar, 255, building 7, 8^th floor − Cerqueira César Zip code: 05403-000 − São Paulo, SP, Brazil Phone: (55 11) 2661-6871 E-mail: marcelnogueira7@gmail.com