. 2017 Jan 16;6:15–27. doi: 10.2147/IPRP.S103783

Table 3.

Summary of systematic reviews of pharmacists’ interventions in diabetes care

Study	Study type and search details	Studies reviewed and settings (n)	Studies and participants	Interventions	Key outcomes			Conclusions and recommendations
Study	Study type and search details	Studies reviewed and settings (n)	Studies and participants	Interventions	Clinical^*	Humanistic	Economic	Conclusions and recommendations
Blenkinsopp and Hassey⁴⁸	Design: systematic review Databases: National Research Register, Cochrane Library, Current-Controlled Trials, National Electronic Library for Health, Medical Sumsearch, Medline, IPA, CINAHL, Amed, PsychINFO, Prodigy, Clinical Evidence, Electronic Medicines Compendium, Diabetes UK, Postgraduate Medicine Patient Notes, NHS Direct, Surgery Door, Patient UK, and Hand searches of non-indexed Medicus journals and conference proceedings Search dates: 1990–2003	Studies: RCT; controlled (1), effect of community pharmacy intervention in diabetes (T1DM or T2DM) (6) Settings: community pharmacy (7)	Total studies: 7 Total participants: 920	Various: clinical review (clinical assessment, goal setting and monitoring), referrals, HbA1c monitoring and feedback, pharmacist-/nurse-led education sessions, adherence service (centered around health beliefs, lifestyle, adverse effects, rationalizing therapy), identification/resolution of DRPs	HbA1c: 60% vs 40% controlled, −0.3% (2/7 studies) BG: −19.3 mg/dL [−1.07 mmol/L] (1/7) Medication problems: reduction in concerns/misbeliefs about medications Adherence: no change to significant improvement (2/7)	Patient knowledge: significant improvement in T2DM patients (1/7 studies)	Cost-effectiveness: savings from reduced use of other health services and changes in medication outweighed the additional costs of providing the community pharmacy-based consultation service (1/7 studies)	Evidence that community pharmacy interventions to improve diabetes care show promise, but require further evaluation
Wubben and Vivian⁵¹	Design: systematic review Databases: MEDLINE (1966), CINAHL (1937); Web of Science (1970); IPA (1970); and Cochrane Library Search dates: start dates shown in parentheses to August 2007	Studies: RCTs; controlled clinical trial (9) and cohort studies (1), pharmacist interventions in outpatient setting (11) Settings: clinics (14), community pharmacy (3), community health clinics (2), and community pharmacy/clinic (1)	Total studies: 21 Total participants: 3,981	Various: included: education on lifestyle or diabetes self-care, drug therapy review, case management, monitoring of glycemic control, and adjustment to patients’ pharmacotherapy regimen as needed	HbA1c: +0.2% to −2.1% (vs control 18/21 studies) SBP: −0.5 to −18.6 mmHg (n = 12/21) DBP: −0 to −17.4 mmHg (n = 12/21) TC: 0 to −39 mg/dL [0 to −1.0 mmol/L] (n = 3/21) LDL: −6 to −15.6 mg/dL [−0.16 to −0.40 mmol/L] (n = 5/21) HDL: +1.95 to −4.3 mg/dL [+0.05 to −0.11 mmol/L] (n = 4/21) TG: −13.0 to −53.4 mg/dL [−0.15 to −0.60 mmol/L] (n = 4/21)	NR	Cost effectiveness: potentially cost effective based on labor resources and costs to deliver DSM service (n = 1/21), service cost to product significant HbA1c reduction (n = 1/21)	Results supportive of a role for pharmacist in diabetes care. Evidence required from prospective studies of the efficacy of pharmacists in improving diabetes outcomes through the provision of self-management education and pharmacologic management. These findings required dissemination beyond the pharmacy profession
Collins et al²¹	Design: systematic review Databases: MEDLINE and Cochrane CENTRAL Search dates: inception to June 2010	Studies: RCT; pharmacist intervention in a diabetic population Settings: clinics (6), hospitals (2), community pharmacy (4), clinic/hospital (1)	Total studies: 14 (12 T2DM only) Total participants: 2,073	Various: two or more of the following components: diabetes education, instruction on diet and exercise, medication counseling and adherence assessment, and adjustment to patients’ pharmacotherapy regimen as needed	HbA1c: −0.76% (vs control; 14 studies, n = 2,073 subjects) FBG: −29.32 mg/dL [−1.62 mmol/L] (4 studies, n = 589 subjects)	NR	NR	Statistically and clinical significant improvement in glycemic control associated with pharmacist interventions. Longer trials trend to greater effect
Omran et al⁵⁰	Design: systematic review Databases: MEDLINE, EMBASE, IPA, CINAHL, and Cochrane Library Search dates: (start date not provided) through to March 12, 2011	Studies: RCT; controlled (6), pharmacist intervention to improve medication adherence in adults with T2DM (2) Settings: clinics (1), hospitals (2), community pharmacy (3), care center (2)	Total studies: 8 (only T2DM) Total participants: 3,930	Various: education-based (individual patient education), behavior-based (unit of use packaging, refill reminders, BGM), affective-based (enhanced communication, regular follow-up, feedback on BG measures) and provider-targeted (improved pharmacist-physician communication) strategies	Adherence: significant improvements in adherence rates (n = 5/8 studies)	NR	NR	Pharmacist intervention generally improve adherence rates, but the impact on clinical outcomes has not been established
Santschi et al²⁰	Design: systematic review and meta-analysis Databases: MEDLINE via PubMed (1950 to March 2012), EMBASE (1980 to March 2012), CINAHL (1937 to March 2012), and Cochrane Central Register of Controlled Trials (up to March 2012) Search dates: start date not provided; end dates as given above	Studies: RCTs; impact of pharmacist care on major CVD risk factors among outpatients with diabetes Settings: Outpatient clinics (11) and community pharmacy (4)	Total studies: 15 (12 T2DM only) Total participants: 9,111	Various: 1) medication management (monitoring of drug therapy such as adjustment and change of medications, medication review from patient interviews, or assessment of medication compliance); 2) educational interventions to patients (medications, lifestyle, and physical activity or about compliance); 3) feedback to health care professional (DRPs identification, recommendation and discussion with physician regarding medication changes or problems of compliance, development of treatment plans); 4) measurement of CVD risk factors	SBP: WMD −6.2 mmHg ([−7.8 to −4.6], P < 0.001) (n = 12/15 studies, 7/12 significant) Studies conducted in community pharmacy greater reduction in SBP (−10.0 mmHg vs −5.5 mmHg) DBP: WMD −4.5 mmHg (−6.2 to −2.8), P < 0.001 (n = 9/15, 3/9 significant) TC: WMD −15.2 mg/dL (−24.7 to −5.7) [−0.39 mmol/L (−0.64 to −0.15)], P = 0.002 (n = 8/15, 2/8 significant) LDL: WMD −11.7 mg/dL (−15.8 to −7.6), [−0.30 mmol/L (−0.41 to −0.20)] P < 0.001 (n = 9/15, 5/9 significant) HDL: WMD +0.2 mg/dL (−1.9 to 2.36) [−0.005 mmol/L (−0.049 to 0.061)], P = 0.846) (n = 6/15, 0/6 significant) BMI: WMD −0.9 kg/m² [−1.7 to −0.1], P = 0.026) (n = 5/15, 2/5 significant)	NR	NR	Evidence to support pharmacist interventions improve management of major CVD risk factors among outpatients with diabetes. Further research needed to assess which pharmacist interventions are most effective, implementable, and least time-consuming and to demonstrate cost-effectiveness of pharmacist interventions in this setting
Pousinho et al⁴⁹	Design: systematic review Databases: PubMed, Cochrane Central Register of Controlled Trials, and Web of Science Search dates: Inception to January 2015	Studies: RCTs; pharmacist interventions vs usual care in T2DM Settings: community pharmacy (8), primary care clinics (8), hospital clinics (16), and hospitals (4)	Total studies: 36 Total participants: 5,761	Various: One or more of the following: counseling and education on diabetes, medication, lifestyle modification, and self-monitoring; reinforcement of medication adherence or complications screening; provision of materials such as educational leaflets and pill boxes; medication review; identification and resolution of drug-related problems; discussions with the primary care provider regarding pharmacotherapy; adjustment of pharmacotherapy; and referrals to other health care professionals	HbA1c: −0.18% to −2.1% (vs control 24/26 studies) SBP: −3.3 to −23.05 mmHg (n = 17/18) DBP: −0.21 to −9.1 mmHg (n = 14/15) TC: +18.95 to −32.48 mg/dL [0.49 to −0.84 mmol/L] (n = 10/13) LDL: +7.35 to −30 mg/dL [+0.19 to −0.78 mmol/L] (n = 12/15) HDL: −5.8 to +11 mg/dL [−0.15 to +0.28 mmol/L] (n = 9/12) TG: +12 to −62 mg/dL [0.14 to 0.70 mmol/L] (n = 9/12) BMI: Reduced (n = 12/14) Adherence: Improved (n = 11/13) 10-Year CVD risk: improved (n = 6/6)	HRQoL: Improved (n = 11 studies)	Cost effective (n = 3/26 studies)	Need for future studies to look at which elements of pharmacists’ interventions contribute to the observed benefits
Aguiar et al¹⁹	Design: systematic review and meta-analysis Databases: PubMed/MEDLINE, Scopus, and Lilacs Search dates: (start date not provided) up to July 2015	Studies: RCTs; effect of pharmacist interventions on glycemic control Settings: hospital outpatient clinics (15), community pharmacy (8), community based clinics (4) and research center (1)	Total studies: systematic review 30, meta-analysis 22 Total participants: systematic review 4,051, meta-analysis 2,715	Variable: Most involved medication review (n = 25/30). Multifaceted actions to address identified DRPs, including educating patients (concerning diabetes, lifestyle, and self-monitoring) or providing medication counseling (100.0%); sending suggestions or recommendations to the physician regarding changes in medication (46.7%); adjusting pharmacotherapy on the basis of protocols previously established in collaboration with the healthcare team (23.3%); and referring patients to other health professional (eg, dentist) (16.7%)	HbA1c: mean difference −0.85% ([95% CI: −1.06, −0.65]; P < 0.0001) Subgroup analysis: no significant difference in the reduction in HbA1c levels according to the country where the study was conducted, type of contact with the patient, whether a medication review was performed; autonomy of the pharmacist to change drug therapy, provision of support resources, frequency of intervention, and adequate random allocation Outpatient clinic vs community pharmacy: HbA1c effect more pronounced, but not significant (−0.98% vs −0.65%; P = 0.08) HbA1c benefit: Greater in those with baseline HbA1c > 9.0% (−1.18% vs −0.63%; P = 0.007)	NR	NR	Pharmacist interventions improve glycemic control in patients with type 2 diabetes, benefits appear greater in younger patients or those with higher baseline HbA1c levels

Notes:

The values shown within square brackets [ ] are calculated values in SI units based on the published results. The values shown within parentheses () represent the number of studies reviewed which addressed the outcome (denominator) and the number which showed positive results (numerator).

Abbreviations: RCT, randomized controlled trial; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus; DRP, drug related problem; BG, blood glucose; NR, not reported; DSM, disease state management; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; LDL, low-density lipoprotein; HDL, high-density lipoprotein; TG, triglyceride; FBG, fasting blood glucose; BGM, blood glucose monitoring; CVD, cardiovascular disease; WMD, weighted mean difference; BMI, body mass index; HRQoL, health-related quality of life; CI, confidence interval; CINAHL, Cumulative Index to Nursing and Allied Health Literature; IPA, International Pharmaceutical Abstracts.