Table 6. The refined Simpler™ pharmacist diabetes intervention tool.

S=Statin	• Statin initiation in patients with CVD
	• aAchieve targets for LDL and TG
	• Statin initiation in patients > 40 years old without CVD
I=Insulin/Glycaemic control	• Insulin initiation if glycaemic control not achieved despite being on two or more oral hypoglycaemic agents
	• Target of HbA1c ≤ 7% if no other complications
	• Management of hypoglycaemia
	• bSelf-monitoring of blood glucose
	• Aim a reduction of HbA1c by 1% if above target HbA1c
	• Initiate/continue metformin if not contraindicated
M=Medication	• Assess medicine related problems
	• Review medication adherence
P=Blood Pressure	• cAchieve BP target
	• ACEI/ARB initiation in patients with/without microalbuminuria /proteinuria
	• Reduce sodium intake (<2400mg sodium/day; 6g/1 teaspoon/day)
	• One or more antihypertensive medicine to be taken at bedtime
L=Lifestyle	• Exercise: 30 mins walking (or equivalent) 5 or more days/week (total ≥150 min/week)
	• Weight loss: Caucasian (BMI< 25 kg/m2), Asian (BMI ≤ 23 kg/m2)
	• Smoking cessation
	• Waist circumference: Caucasian (<94 cm in men, <80 cm in women, Asian (≤90 cm in men, ≤80cm in women)
	• Alcohol intake: ≤2 standard drinks (20 g) per day for men
	• Management of stress & diabetes related distress
	• Erectile dysfunction: recommend Phosphodiesterase-5 inhibitor as first line therapy for male patients
	• Foot care
	• Diet advice using plate model
	• Annual eye assessment
	• Address sleep hygiene
E=Education	• Knowledge & understanding of medicine
	• Medicine storage
	• Medication optimisation during fasting month for Muslims and other religious groups
R=Cardiovascular Risk	• Aspirin therapy as secondary prevention in those with diabetes with history of CVD
	• Use of Framingham risk calculator to calculate CVD risk and educate patients
	• dAspirin therapy (75mg-162mg/day) as primary prevention to decrease CVD risk (10 year risk>10%, Framingham)

^aAustralia: Low density lipoprotein(LDL) <2.0 mmol/L, Triglyceride (TG) <2.0 mmol/L, Malaysia: LDL <2.6 mmol/L, TG <1.7 mmol/L

^bAustralia: (6.0-8.0 mmol/L fasting),(8.0-10.0 mmol/L-2h postprandial); Malaysia:(4.4-7.0 mmol/L fasting),(4.4-8.5 mmol/L-2h postprandial)

^cAustralia:≤140/90 mmHg, with albuminuria/proteinuria<130/80 mmHg; Malaysia: ≤135/75 mmHg

^dRecommendations according to 2016 ADA Standards of medical care in diabetes5; Malaysia Clinical Practice Guidelines recommend aspirin therapy if 10 year risk>10% only for patients aged 65 years and above2

ACEI=Angiotensin converting enzyme inhibitors; ARB= Angiotensin 11 receptor blockers; BP= Blood pressure; BMI=Body mass index; CVD=Cardiovascular disease; HbA1c=glycosylated haemoglobin and reflects average glycaemia the preceding 6-8 weeks LDL=Low density lipoprotein; TG=Triglyceride