Pharmacists should take ‘active role’ in diabetes: study

Girl giving herself insulin shot

A systematic review and meta-analysis has found pharmacist-led education has a positive effect on HbA1c levels and self-care practices among type 2 diabetes patients

Pharmacist-led educational interventions have a significantly positive effect on HbA1c levels and self-care practices among type 2 diabetes patients, according to a systematic review and meta-analysis published this week in the journal Patient Preference and Adherence.

Researchers from the School of Pharmacy at Monash University Malaysia searched five electronic databases for randomized clinical trials (RCTs) examining the effectiveness of pharmacist-led educational interventions, directed at type 2 diabetes mellitus patients only.

Of 469 studies identified and assessed for eligibility, 458 were excluded with reasons.

The review included 11 studies involving 1,544 patients.

Meta-analysis demonstrated that pharmacist-led interventions had a significant effect on lowering of the levels of glycated haemoglobin (-0.66; 95% CI [-0.83, -0.50]; I 2 =58.3%; P=0.008), in comparison to usual care.

Unfortunately “usual care” is not explicitly defined in the review.

Self-care activities were assessed by using Summary of Diabetes Self-care Activities tool in eight studies.

Overall meta-analysis of self-care activities for included studies demonstrated a significant effect of pharmacist-led interventions on improvement of self-monitoring of blood glucose (1.62; 95% CI [0.92, 2.32]; I 2 =70.5%; P=0.005), foot care (1.20; 95% CI [0.49, 1.90]; I 2 =95.0%; P,0.001), and overall diet (1.16; 95% CI [0.38, 1.93]; I 2 =64.2%; P=0.094).

Risk of bias assessment showed most of the studies (>80%) were free from attrition bias, selection bias, performance bias, detection bias, and reporting bias.

A funnel plot test and Eggers test indicated slight publication bias.

To address the issue of high heterogeneity, subgroup meta-analysis was performed on the basis of quality of the studies.

The findings of subgroup meta-analysis revealed that the studies with low risk of bias had a comparatively larger effect of pharmacist-led interventions on foot care (1.46; 95% CI [0.58, 2.35]; I 2 =94.1%), general diet (0.94; 95% CI [-0.13, 2.02]; I 2 =88.4%), self-monitoring of blood glucose (2.25; 95% CI [0.88, 3.62]; I 2 =72.9%), and specific diet (WMD =0.21; 95% CI [-0.82, 1.24]; I 2 =64.4%), when compared with studies with unclear or high risk of bias.

Altogether the findings of this review demonstrate a significantly positive effect of pharmacist-led educational interventions on HbA1c levels and self-care practices among type 2 diabetes mellitus patients, say the authors.

Glycemic control and diabetes-related self-care activities are surrogate markers for disease progression and its related complications, they say.

“Pharmacists should take an active role in providing diabetes self-care education in conjunction with euglycemic medicines, in order to improve patient outcomes,” the researchers conclude.

See the full article here

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1 Comment

  1. Angus Thompson

    At face value this is great news, but it would be great to see work on glycaemic control in T2DM also looking at appropriateness. From my experience doing HMRs, there are many elderly patients, often with significant comorbidities with excessively tight glycaemic control, that probably does more harm than good, or at the very least increases medication burden and cost. Whilst recent years have seen a welcome move to treat people with T2DM more individually, rather than apply blanket targets, we still have a way to go. In my own practice, my recommendations are now often being informed by the ACP Guidance Statement from the US, available here:

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