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Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: Randomized controlled trial
Abstract
Aims
The primary aim of this study was to evaluate the impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes patients in Jordan.
Methods
A randomized controlled clinical trial was conducted on 106 patients with uncontrolled type 2 diabetes seeking care in the diabetes clinics at Jordan University Hospital. Patients were randomly allocated into control and intervention group. The intervention group patients received pharmaceutical care interventions developed by the clinical pharmacist in collaboration with the physician while the control group patients received usual care without clinical pharmacist's input. Fasting blood glucose and HbA1c were measured at the baseline, at three months, and six months intervals for both intervention and control groups.
Results
After the six months follow-up, mean of HbA1c and FBS of the patients in the intervention group decreased significantly compared to the control group patients (P < 0.05). Also, the results indicated that mean scores of patients’ knowledge about medications, knowledge about diabetes and adherence to medications and diabetes self-care activities of the patients in the intervention group increased significantly compared to the control group (P < 0.05).
Conclusions
This study demonstrated an improvement in HbA1c, FBS, and lipid profile, in addition to self-reported medication adherence, diabetes knowledge, and diabetes self-care activities in patients with type 2 diabetes who received pharmaceutical care interventions. The results suggest the benefits of integrating clinical pharmacist services in multidisciplinary healthcare team and diabetes management in Jordan.
... The predominant intervention type across the studies included was educational (n = 33), emphasising various aspects of diabetes management, such as promoting a healthy lifestyle, diabetes self-care practices (such as foot care and blood glucose monitoring), dietary management, weight reduction, blood pressure control, smoking cessation, regular medical check-ups, physical activity and discussion of symptoms and risks associated with diabetes complications ( Additionally, certain studies involved adjusting and administering insulin or oral antidiabetic therapy alongside medication reconciliation and education (Al Mazroui et al. 2009;Wishah, Al-Khawaldeh, and Albsoul 2015), as well as the application and use of glucose monitoring systems or telemonitoring devices (Al Hayek, Robert, and Al Dawish 2021;Al-Ofi et al. 2019). The comparison groups, on the contrary, typically received standard lifestyle advice or nonpersonalised counselling from healthcare providers. ...
... The evaluation of the intervention effect on physical activity included eight studies (Appendix S2). Among these studies, six reported a significant positive effect of the intervention, evident at both short and long-term follow-up periods (Abduelkarem and Sackville 2008;Agbaria et al. 2020;Ba-Essa et al. 2015;Jarab et al. 2012;Mohamed et al. 2013;Wishah, Al-Khawaldeh, and Albsoul 2015). Additionally, five studies assessed the general diet outcomes, with three of them reporting a significant effect of the intervention on dietary behaviours (Abduelkarem and Sackville 2008;Jarab et al. 2012;Wishah, Al-Khawaldeh, and Albsoul 2015). ...
... Among these studies, six reported a significant positive effect of the intervention, evident at both short and long-term follow-up periods (Abduelkarem and Sackville 2008;Agbaria et al. 2020;Ba-Essa et al. 2015;Jarab et al. 2012;Mohamed et al. 2013;Wishah, Al-Khawaldeh, and Albsoul 2015). Additionally, five studies assessed the general diet outcomes, with three of them reporting a significant effect of the intervention on dietary behaviours (Abduelkarem and Sackville 2008;Jarab et al. 2012;Wishah, Al-Khawaldeh, and Albsoul 2015). These successful interventions for physical activity and general diet utilised various approaches, combining interventions with programme managers who maintained continuous contact with participants through WhatsApp, telephone calls, brochures and reminders following the intervention completion (Abduelkarem and Sackville 2008;Agbaria et al. 2020;Jarab et al. 2012;Wishah, Al-Khawaldeh, and Albsoul 2015). ...
Aim
To identify, describe, and critically evaluate the effects of various interventions on diabetes management outcomes among Arabs with diabetes.
Design
A systematic review.
Data Sources
The search was conducted across three databases: PubMed, CINAHL and the Cochrane Collaboration in December 2023.
Review Methods
Screening involved randomised controlled trials and nonrandomised studies that focused on the effects of interventions on diabetes management among Arab with diabetes. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist guided the review process. Two researchers independently applied eligibility criteria. Data extraction captured key study details, and methodological quality was assessed using Downs and Black's checklist. This review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42024555668).
Results
Thirty‐five articles were reviewed, yielding 65 outcomes. Effective interventions included personalised care, patient‐centred education and direct patient contact through lifestyle modifications, advice, feedback, motivational conversations and calls. These approaches improved haemoglobin A1c, fasting blood glucose, physical activity and medication adherence. Conversely, nonpersonalised remote monitoring and social media interventions showed no significant improvements. Notably, tailored nutritional and physical activity advice positively impacted body mass index and systolic blood pressure among Arab women with diabetes.
Conclusion
The findings underscore the effectiveness of personalised care and direct patient contact in optimising diabetes management among Arabs with diabetes.
Impact
This review highlights the importance of prioritising direct patient contact over remote methods such as social media in interventions on diabetes management among Arabs with diabetes. It emphasises the need for culturally sensitive approaches, particularly for women.
Patient or Public Contribution
No patient or public contribution, as this study constitutes a review of existing research.
... A pharmacist-led team has been shown to significantly improve treatment adherence and reduce hospitalizations in the intervention group as a result of medication therapy management interventions for a large proportion of patients 9 . It has also been demonstrated that CP interventions significantly reduce HbA1c and fasting blood glucose levels in TIIDM patients; in addition, CP increases the level of knowledge of patients about their disease and medi-cations, improve adherence with treatment, and contribute to better performance of diabetes self-care activities 10 . ...
... Considering its chronic nature, the impact of successful type 2 diabetes treatment on patients' QoL is significant. At this point, communication, cooperation, and harmony between the physician, CP, and patient are highly effective in increasing the success of treatment, preventing the development of side effects, and complications; and reducing the cost of treatment [7][8][9][10] . ...
... A significance was not observed in body mass index in our study which was consistent by literature 17 . Some other studies showed no significant reduction in body mass index in patients after CP intervention 10,18 . However, in a study investigating the effect of pharmacist education on type 2 diabetes patients in a community pharmacy setting in Türkiye, a significant decrease in body weight and body mass index of the participants was obtained 12 . ...
... Three studies used a combination of three intervention delivery methods [35][36][37]. The most common combination of delivery methods was face to face meeting and phone calls (n = 22) [35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. During the interventions, several delivery aids were used, such as videos (n = 2), printed materials consisting of a summary of important information for patients (n = 20), email reminders (n = 1), patient diaries (n = 11), and pillboxes (n = 6). ...
... Most studies incorporated two or more intervention strategy categories. In particular, 17 combined two strategies [16,28,33,34,36,39,41,45,48,55,[63][64][65][66], 18 combined three [18,19,23,24,26,30,38,44,46,50,51,53,54,[67][68][69][70][71], 16 combined four [20,22,25,27,29,32,37,42,43,47,49,52,56,[72][73][74], 2 combined five [75,76], and 1 combined six [31]. The most commonly utilized intervention strategy was diabetes education (n = 49), whereas the least utilized service content category was peer support (n = 1). ...
... The follow-up periods of the pharmacists' interventions differed in each study and ranged between 1.5 [67] and 24 months [42]. One study followed up patient for 2 months [59], nine for 3 months [16,52,53,56,60,61,64,70,74], five for 4 months [21,25,31,45,68], three for 5 months [23,50,53], fourteen for 6 months [22,27,30,36,39,40,44,46,49,62,73,75], three for 8 months [18,55,72], four for 9 months [29,33,37,41], eighteen for 12 months [20,24,26,28,35,38,43,47,48,51,54,63,65,66,69,71,76,77], one for 13 months [32] and another one for 16 months [10]. The most common follow-up period for the interventions was 12 months (n = 19, 31.1%), and the mean intervention duration was 7.8 months. ...
Background
There is increasing intervention activities provided during pharmacist-led diabetes management. Nevertheless, there is an unclear definition of the activities involved during the intervention. Thus, this study aimed to describe the type of intervention strategies and service model provided during pharmacist-led type 2 diabetes management and service outcomes.
Methods
This study utilized the scoping review methodology of the Joanna Briggs Institute Reviewers’ Manual 2015. Articles on pharmacist-led diabetes management focusing on the service content, delivery methods, settings, frequency of appointments, collaborative work with other healthcare providers, and reported outcomes were searched and identified from four electronic databases: Ovid Medline, PubMed, Scopus, and Web of Science from 1990 to October 2020. Relevant medical subject headings and keywords, such as “diabetes,” “medication adherence,” “blood glucose,” “HbA1c,” and “pharmacist,” were used to identify published articles.
Results
The systematic search retrieved 4,370 articles, of which 61 articles met the inclusion criteria. The types of intervention strategies and delivery methods were identified from the studies based on the description of activities reported in the articles and were tabulated in a summary table.
Conclusion
There were variations in the descriptions of intervention strategies, which could be classified into diabetes education, medication review, drug consultation/counseling, clinical intervention, lifestyle adjustment, self-care, peer support, and behavioral intervention. In addition, most studies used a combination of two or more intervention strategy categories when providing services, with no specific pattern between the service model and patient outcomes.
... The 21 studies involved in this review were conducted in different countries all over the world. Two studies were conducted in Europe (United Kingdom and France) [25,26], three in the USA [27][28][29], one in Australia [30], two in Brazil [31,32], one in New Zealand [33], twelve studies in the Middle East and Asia (Malaysia, Iran, Pakistan, India, Ethiopia, South Thailand, Cyprus and Jordan) [34][35][36][37][38][39][40][41][42][43][44][45], respectively. ...
... Many experiences had a positive impact, increasing patients' adherence and refining glycemic control levels [32,34,45]. ...
... The majority of the reviewed studies were randomized controlled trials, and the randomization process was typically completed at the pharmacy level. This could be owing to authors attempting to minimize contamination by control patients receiving the intervention [25,26,[29][30][31][34][35][36][37]41,[43][44][45] The majority of the included studies used the Morisky Medication Adherence Scale (MMAS), which has also been a basis for developing derived scales. Other studies either used the medication possession ratio (MPR), counting pills (CP) or the proportion of days covered (PDC) to measure the adherence level of patients. ...
Type 2 diabetes mellitus has been assessed as a widespread disease globally. Unfortunately, this illness can occasionally go undetected and without symptoms until it reaches the emergency condition, and this can be notably true in patients who do not receive routine medical care. Pharmacists are the foremost accessible health care providers. They can help patients select the most appropriate hypoglycemic management strategy through their experiences. This review aimed to provide an overview of the literature published on community pharmacists' interventions that are currently used and their usefulness in improving patient adherence and glycosylated hemoglobin (HbA1c) levels. Relevant studies were retrieved through a comprehensive search of three databases, PubMed/Medline, Web of Science, and CINAHL (2010 to 2020). In total, 8362 publications were identified. The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)". After applying inclusion and exclusion measures, 21 articles were deemed relevant. In pharmacists' interventions in diabetes care, patient education and counseling were the most common intervention methods. Essentially, this systematic review provides evidence and identifies the key features that may predict success in enhancing clinical outcomes and patient adherence to treatment. Based on our findings, we suggest further investigations of the root causes of non-adherence problems.
... Such modifications include healthy eating habits, regular exercise, self-blood glucose testing, and adherence to medication (Inzucchi et al., 2012). Inadequate self-care practices have been reported in people with diabetes living in low-or middle-income countries (Sarkar et al., 2006;Jarab et al., 2012;Wishah et al., 2015). Recently published data show poor self-care activities among Pakistani people with diabetes (Bukhsh et al., 2018a;Bukhsh et al., 2019). ...
... Glycemic control can significantly reduce the risk of diabetesassociated complications (Wishah et al., 2015). The patients with poor glycemic control (HbA1c ≥ 7%) are usually at high risk of acquiring diabetes-driven complications (Association AD, 2013). ...
... On the other hand, exercise and diet were the least practiced self-care practices reported by the patients of both groups at the baseline. Poor self-care practices, especially for diet and exercise have also been reported in previous studies (Sarkar et al., 2006;Nelson et al., 2007;Wishah et al., 2015). These findings indicate people with diabetes have either inadequate knowledge about the importance of regular exercise and healthy eating or they feel it difficult to perform these self-care activities. ...
Introduction: There is a little evidence on efficacy of pharmacy-based interventions on clinical outcomes of type 2 diabetes mellitus (T2DM) patients in Pakistan.
Objective: To appraise the impact of pharmacist-led self-care education on glycemic control, self-care practices and disease knowledge of T2DM patients with poor glycemic control (HbA1c ≥ 7%).
Methods: In this 6-months, randomized controlled trial (RCT), n = 75, T2DM patients seeking care at a diabetes clinic were randomized in to two groups. Intervention group (n = 38) received two face-to-face educational sessions (at enrollment and on week 12), whereas control group (n = 37) received usual care. Outcome measures such as glycemic control, self-care practices and disease knowledge were assessed at the time of enrollment and after 6-months in both groups.
Results: Thirty-three intervention and thirty-three participants from the control group completed the study. Mean glycated hemoglobin (% HbA1c) significantly reduced in the intervention group from 9.00 ± 1.43 to 8.09 ± 1.16 (p < .01). However, no significant change was observed in the control group (9.20 ± 1.24 to 8.93 ± .97; p = .06). Cohen’s d effect size of the intervention on HbA1c was .78. Percentage of participants achieving glycemic control (HbA1c < 7%) were significantly higher (p < .05) in the intervention group as compared to the control group (twenty-four vs. six), after 6 months of the trial. A significant (p < .01) improvement in mean scores for disease knowledge and self-care activities was also observed in the intervention group participants, whereas no significant improvements (p > .05) were observed in the control group.
Conclusion: The study demonstrated an improvement in glycemic control, disease knowledge and self-care activities of T2DM patients who received pharmacist-led educational intervention. The study findings support clinical significance of integrating pharmacy-based interventions in diabetes management.
... The mean HbA1c value decreased from baseline to followup in the intervention group in all studies (Online appendix 3), but this decrease reached statistical significant for only sixteen studies (47%). 23,25,[27][28][29]35,[37][38][39]41,42,45,50,52,56,57 In these studies, the difference showed in HbA1c change from baseline to final follow-up between the intervention group and the control group ranged from -0.05% to -2.1%. Regarding blood glucose, 22 studies reported this parameter as an outcome measure (Online appendix 3). ...
... Only six studies (27%) reported a statistically significant decrease in blood glucose (fasting or postprandial). 39,40,42,45,46,56 Overall, the difference in change between both groups, which ranged from -7.74 mg/dL to -76.32 mg/dL. ...
... The difference in change between the two groups ranged from +3.45 mmHg to -10.6 mmHg and was shown to be statistically significant in only seven studies (33.3%). 31,35,[39][40][41][42]45,50,53,56,57 As for diastolic blood pressure (DBP), 15 studies reported data on this outcome (Online appendix 3). However, only three studies revealed a statistically significant difference in change from baseline to final follow-up between both groups. ...
Background: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements.
Objective: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes.
Methods: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities.
Results: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable.
Conclusions: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.
... They varied in their quality and reporting of their findings conducted in several setting including: standard care, pharmaceutical care or family practice in the UK, Spain or elsewhere in the world [20][21][22][23][24][25][26][27][28] . Among the included studies 24 were randomised controlled studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][44] and one was cluster randomised 36 . All studies were published from 2009 onwards. ...
... Most of the included studies (n = 12) were conducted in Asia, 22 36 38 North America (n = 5), 25 26 29 32 42 South America (n = 2), 23 37 and Africa (n = 1). 30 The median follow-up time was 6 months, 22,23,25,28,30,33,36,37,38,40,41,42,44 two studies had a followup time of less than 6 months 27,39 and ten of more than 6 months. 20 The majority of the studies focused primarily on diabetes mellitus type 2 patients, 20,[22][23][24][25][26][27][28]30,31,[33][34][35][36][37][38][39][40][41][42][43][44] (n=22), one study included both type 1 and type 2 patients, 32 and one study did not specify the type of diabetes. ...
... 30 The median follow-up time was 6 months, 22,23,25,28,30,33,36,37,38,40,41,42,44 two studies had a followup time of less than 6 months 27,39 and ten of more than 6 months. 20 The majority of the studies focused primarily on diabetes mellitus type 2 patients, 20,[22][23][24][25][26][27][28]30,31,[33][34][35][36][37][38][39][40][41][42][43][44] (n=22), one study included both type 1 and type 2 patients, 32 and one study did not specify the type of diabetes. 29 ...
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
... 19 There is, however, some research on medication self-management in other populations, such as persons with diabetes. [20][21][22] For example, Cani and colleagues conducted a randomized controlled trial to examine the effectiveness of a clinical pharmacy program on health outcomes (HbA1c levels, medication and diabetes knowledge, adherence, quality of life) among adults with type 2 diabetes. 20 The intervention was comprised of individualized pharmacotherapeutic plans, which included information on indication, dosage, side effects and storage of medications, as well as a pill organizer, written information and diabetes education. ...
... Similarly, a randomized controlled trial conducted by Wishah and colleagues examined the impact of a pharmaceutical care intervention on glycemic control, diabetes and medication knowledge, adherence and self-care activities among patients with type 2 diabetes. 21 Participants in the intervention group (n = 52) showed significantly improved glycemic control, knowledge of diabetes and medications, adherence and self-care activities when compared to the control group (usual care). ...
... Although some medication self-management programs have resulted in improved medication adherence in individuals with chronic illness, 20,21 there remains a paucity of research on medication selfmanagement among persons with SCI/D, as the majority of literature is focused on adherence rather than the broader conceptualization of medication self-management (e.g. monitoring medications, completing health assessments, observing the safety and efficacy of medications). ...
Rationale:
Spinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/service providers and persons with SCI/D experience medication self-management.
Objective:
To explore attitudes and experiences of medication self-management from the perspectives of persons with SCI/D and providers, and to explore the extent to which the Taxonomy of Everyday Self-management Strategies (TEDSS) framework captured participants' experiences with medication self-management.
Methods:
In-depth, semi-structured interviews were conducted by telephone until data saturation was reached. Interviews were transcribed verbatim and analyzed using constant comparative approaches. The TEDSS framework was adapted and applied deductively.
Results:
Fifty-one individuals participated in this study, 32 providers and 19 persons with SCI/D. Disease controlling strategies was the domain discussed in most detail by all participants. In this domain, participants discussed managing medications and treatments, monitoring/managing side effects, and controlling complications. Process strategies (problem-solving, decision-making) and resource strategies (seeking support) were the next most frequently discussed domains. Among all participant groups, there was a lack of detailed discussion of social interactions, health behaviour, and internal strategies. Medication self-management support was not extensively discussed by any group.
Conclusion:
This study highlighted the complex nature of medication self-management. While persons with SCI/D and providers discussed similar components of the TEDSS framework, providers had minimal reflections on the impact of medication self-management on everyday life. This study identified the need for explicit discussions between providers and persons with SCI/D, involving all components of self-management and self-management support in order to improve medication self-management.
... The final sample comprised seven studies. (21,(26)(27)(28)(29)(30)(31) The database search strategy adopted yielded 185 results. Seven duplicates were eliminated in the screening process. ...
... Attrition and reporting biases were limited to one study that retained high risk of bias due to lack of description of one of the secondary endpoints. (27) As for other biases, only two studies were thought to be free from other sources of bias (2/15; 13.4%). Thirteen studies included in this systematic review and metaanalysis (13/15; 86.7%) were thought to have unclear risk of bias, given limitations presented by authors were deemed insufficient to estimate whether significant risk of bias might impact participant outcomes (Figure 2 and Appendix B). ...
... Ten studies were included in the metaanalysis, (21,(27)(28)(29)32,34,(36)(37)(38)(39) all of them with high heterogeneity for all endpoints (I 2 97% to 99%; p<0.001). The efficacy of pharmaceutical care to promote reduction of SBP, HbA1c, fasting glucose and TG levels and increase of HDL levels was demonstrated in all studies, in spite of significant heterogeneity. ...
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.
... [26] Some of the included studies reported personalized kind of interventions that were based on specific needs of diabetic patients. [23,25,26,[30][31][32]34] The type, intensity, and frequency of interventions were different in all the included studies. The number of visits for face-to-face interactions was also different in all the included studies. ...
... Thirteen included studies measure the lipid profile of the patients. [11,12,17,19,21,22,25,27,[29][30][31][32]35] Most of the studies reported the improvement in lipid profile in intervention group, whereas only four [12,17,30,31] studies showed no effect of the intervention in the intervention group. ...
... Thirteen included studies measure the lipid profile of the patients. [11,12,17,19,21,22,25,27,[29][30][31][32]35] Most of the studies reported the improvement in lipid profile in intervention group, whereas only four [12,17,30,31] studies showed no effect of the intervention in the intervention group. ...
A strict and adherence treatment is required by the patient with diabetes mellitus and it demands a proper self-medication by the patient. Pharmacists are involved in providing self-management support to the patients. This review evaluates the interventions of pharmacist for patients to improve self-management with diabetes mellitus and also to improve the clinical outcomes of diabetes mellitus. A comprehensive literature search was performed by using different keywords “pharmacist-led intervention,” “diabetes,” “effect of pharmacist on outcome of diabetes,” and “self-management of diabetes” with the help of various electronic databases such as PubMed, Science Direct, Embase, Web of Science, and the Cochrane Library from the beginning of the database through September 2018. The primary outcome was glycated hemoglobin (HbA1c), whereas the secondary outcomes were blood glucose level, blood pressure (BP) measure, body mass index, lipids, adherence to medication, and quality of life. Twenty-five studies comprising 2997 diabetic patients were included in the analysis. Pharmacist-led intervention was involved in all included studies in the form of education on diabetes and its complications, medication adherence, lifestyle, and education about self-management skills. Pharmacist-led interventions are able to reduce HbA1c levels with a mean of 0.75%. Most studies do not expose the material and methods used in pharmacist-led intervention. The variation in the reduction of HbA1c, fasting blood sugar, BP, and lipid profile was due to the lack of this standardization. The included studies indicated that pharmacist-led interventions in diabetes mellitus can significantly improve the outcomes of diabetes mellitus and its complication later on. Hence, these long-term improvements in outcomes added more value of pharmacists in health-care system of the world.
... Similar to our findings, numbers of previously reported studies have suggested that pharmacist managed diabetes mellitus care could improve LDL-C, HDL-C, TG and cholesterol levels 16,[23][24][25][29][30][31][32] . The proportion of patients who achieved target LDL-C values (<100mg/dl) and HDL-C (40mg/dL) in our study is in agreement with the study reported by Ali et al. 25 , Mourao et al. 17 , Wishah et al. 18 , Al Mazroui et al., 20 and Hening et al., 33 . Analysis of UKPDS data by Turner et al. indicated that the risk of either angina pectoris or myocardial infarction increases by 1.57 for every 1 mmol/L increase in LDL-C level, and patients with LDL-C levels higher than 3.9 mmol/L were 2.3 times as likely to develop coronary artery disease than those with LDL-C levels less than 3 mmol/L 34 . ...
... We found that compared to baseline, in the 6-month post-intervention patients who received the clinical pharmacy service in the present study demonstrated significantly better self-reported medication adherence, corroborating earlier researches, Mazroui et al. 10 , Erku, et al. 39 , Korcegez et al., 22 and Jarab et al., 16 . Wishah et al. 18 , Obreli-Neto et al., 23 and Chung et al., 32 reported that pharmacist intervention resulted in significant improvements in medication adherence. The finding is similar to previous studies demonstrating the effect of pharmacist interventions to improve medication adherence 21,31,[40][41][42][43][44][45] . ...
Background:
The role of clinical pharmacist in hospital settings of Ethiopia is still new and infant.
Objective:
To evaluate the impact of pharmaceutical care on clinical outcome and medication adherence in type 2 diabetes mellitus (T2DM) patients.
Methods:
A single cantered, pre-post interventional study design was carried out by enrolling 100 uncontrolled T2DM patients from March 1-August 30, 2020. The intervention package included assessment of pharmacological and non-pharmacological needs, counselling patients in person at the clinic, and providing educational materials.
Results:
Of the 100 patients initially enrolled, 87(87%) completed the follow-up and included in the final data analysis. The intervention showed a decrease in average FBG, systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-C) by 47.3 mg/dL, 22.6mmHg and 31.4mg/dL, while high density lipoprotein cholesterol (HDL-C) and estimated glomerular filtration rate (eGFR) exhibited significant increase by 13.4 mg/dL and 11.5 ml/min/1.73m2 respectively (p<0.0001). In addition, diastolic blood pressure, lipid values, kidney function parameters, and liver function parameters showed significant decrease in post intervention compared to pre-intervention (p<0.05). Medication adherence of the patients increased significantly at 6-month follow-up (p<0.001).
Conclusion:
These results also suggest the benefits of integrating clinical pharmacist services in multidisciplinary healthcare teams and diabetes management in Ethiopia.
... All patients in the RCTs were adherent to the assigned intervention, except for one study. 40 For the non-RCTs (n = 9), most of the studies (n = 6) were of good quality as they addressed all the components of the MMAT tool, 44,[47][48][49][50]69 except for three studies in which the first one did not account for confounders; 70 the second, neither accounted for confounder nor had a complete data outcome; 64 and in the last, it was not obvious if the intervention was administered as intended or if there was complete outcome data. 36 ...
... In the current review, four studies showed an improvement in Hb A1C between the intervention and control groups in the range of 0.77-1.86%. 38,[40][41][42] Furthermore, a systematic review of pharmacist care in hypertension management, with the main intervention being medication management and hypertension education, reported a significant reduction in systolic blood pressure (10.7 ± 11.6 mm Hg) with no significant reduction detected in the control group (3.2 ± 12.1 mm Hg). 75 This assessment found that the majority of the included studies were conducted in outpatient clinics (20 studies). ...
What is known and objective:
The pharmacist's role has evolved dramatically over the last few decades and shows considerable impact globally. The aim of this systematic review was to describe the nature and extent of studies evaluating the impact of pharmacist-provided services on clinical, humanistic and economic outcomes in different healthcare settings across the Arab world.
Methods:
A systematic literature search was conducted using the following databases from their inception until June 2020: Cochrane, Embase, MEDLINE, PubMed, ScienceDirect and Scopus. Reporting was done according to PRISMA guidelines, and the quality assessment utilized the Mixed Methods Appraisal Tool.
Results and discussion:
Thirty-five eligible studies were included in this review, the majority of which were randomized controlled trials (RCT) (n = 26) conducted in hospital settings (n = 26). Most of the studies involved patients with specific medical conditions (n = 29) and pharmacist's interventions involved mainly medication therapy management (n = 32), counselling and education (n = 29), and medication therapy recommendations (n = 12). Several studies showed a positive impact (i.e., a statistically and/or clinically significant difference in favour of pharmacist-provided care or intervention) of pharmacist-provided services on clinical (n = 28), humanistic (n = 6) and economic (n = 5) outcomes. Conversely, five studies showed neutral or mixed effect of pharmacist interventions on clinical and humanistic outcomes.
What is new and conclusion:
The findings of this systematic review demonstrate a positive impact of pharmacist-provided services on clinical, humanistic and economic outcomes across diverse settings in the Arab world. Most of the included studies evaluated clinical outcomes and were from hospital setting. Directed approaches are needed to advance pharmacy practice across various healthcare settings in the Arab world.
... In the DIMM clinic, which employs both patient-specific education and comprehensive medication management, we observed a more robust mean HbA1c reduction for our patient population. In a study with a patient care intervention similar to the DIMM clinic, the authors did examine both HbA1c and self-reported adherence, although the researchers did not include exploration of the relationship between HbA1c and adherence as in our study [22]. In that study, pharmacist collaboration with physicians in the development of diabetes care plans with respect to medication management and patient education resulted in a mean HbA1c reduction of 1.7% and a significant improvement in mean self-reported adherence over a period of 6 months [22]. ...
... In a study with a patient care intervention similar to the DIMM clinic, the authors did examine both HbA1c and self-reported adherence, although the researchers did not include exploration of the relationship between HbA1c and adherence as in our study [22]. In that study, pharmacist collaboration with physicians in the development of diabetes care plans with respect to medication management and patient education resulted in a mean HbA1c reduction of 1.7% and a significant improvement in mean self-reported adherence over a period of 6 months [22]. In comparison, in the DIMM clinic, we observed a slightly higher mean HbA1c reduction of at least 2.2% and no significant difference in mean self-reported adherence over a similar time period. ...
Diabetes complications remain a leading cause of death, which may be due to poor glycemic control resulting from medication nonadherence. The relationship between adherence status and HbA1c (glycemic control) has not been well-studied for clinical pharmacist interventions. This study evaluated medication adherence, patient satisfaction, and HbA1c, in a collaborative pharmacist-endocrinologist diabetes clinic over 6 months. Of 127 referred, 83 patients met the inclusion criteria. Mean medication adherence scores, considered "good" at baseline, 1.4 ± 1.2, improved by 0.05 points (p = 0.018), and there was a 26% increase in patients with good adherence. A significant improvement of 0.40 percentage points (95% CI: -0.47, -0.34) was observed in mean HbA1c across the three time points (p < 0.001). Mean total satisfaction scores were high and increased, with mean 91.3 ± 12.2 at baseline, 94.7 ± 9.6 at 3 months, and 95.7 ± 10.8 at 6 months (p = 0.009). A multimodal personalized treatment approach from a pharmacist provider significantly and positively impacted glycemic control regardless of self-reported medication adherence, and patient satisfaction remained high despite changing to a clinical pharmacist provider and increased care intensity.
... This result was similar to those of previous studies, which have shown a significant decrease in HbA1c, ranging from 0.69% to 1.70%, after pharmacist counseling. [3,7,15,16] Another study conducted by Wishah Ruba et al. [17] showed a decrease in HbA1c from 8.9% to 7.2% (1.7%) after a 6 month pharmacist intervention in the IG group. However, the HbA1c value did not reach the controlled category after the intervention, while the cCG showed a decrease in HbA1c from 8.2% to 7.9% (a mean decrease of 0.3%). ...
... Similar studies have also shown a significant 0.24 mmol/L reduction in TC after pharmacist counseling. [7,17,20] However, there was no significant change in HDL-c levels in the IG. Similar findings were also reported in a Brazilian study conducted by Plaster et al., [21] who found that intervention led to a decrease in LDL-c levels from 149 to 111 mg/dL. ...
Objective:
In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets.
Methods:
A quasi-experimental study with a pretest-posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles.
Findings:
After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent ("not often") consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7).
Conclusion:
The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.
... Malathy et al., from India, found that the overall knowledge, attitude, and practice (KAP) scores of the interventional group were significantly higher [38]. A Jordanian study by Wishah et al. reported a significant improvement in the mean knowledge score of the intervention group compared to the control group [39]. These results indicate that knowledge among the interventional group increased significantly from baseline. ...
Background: Diabetes mellitus is a complex condition to manage. Patients with a greater understanding and knowledge of their condition might achieve better glycemic control than others. This study aimed to evaluate the impact of clinical pharmacist-led diabetes education on the knowledge and attitude of individuals with type II diabetes mellitus (T2DM). Methods: This study was a quasi-experimental study which was conducted at a diabetes clinic in Khartoum, Sudan. The study population was adult individuals with T2DM who attended the diabetes clinic. The estimated sample size was 182 participants. The participants were selected randomly by a simple random sampling method. The knowledge and attitudes of the participants were assessed at baseline and at the end of the study after 12 months. The intervention was carried out through educational materials about diabetes and medications for its treatment. Results: The majority of the participants were females. The mean age was 54.5 (±10) years. Most participants had a family history of diabetes (69.2%). The mean knowledge score after the intervention was increased by 1.4 (±0.1) from baseline, p value (<0.001), while the mean attitude score was increased by 1.7 (±0.2) from baseline, p value (<0.001). At baseline, 14.8% of the participants had a high level of knowledge and 18.7% had a negative attitude, while after intervention for 12 months, 28.5% of them had a high level of knowledge and 16.8% had a negative attitude (p values < 0.001, 0.032, respectively). Conclusions: The knowledge of and attitudes towards diabetes differed significantly as a result of the educational program provided by the clinical pharmacist.
... Te pathogenesis of DN is multifactorial, and it results from a combination of factors such as prolonged high blood glucose levels, infammation, and oxidative stress, and addressing all these factors simultaneously can be challenging that necessitates combination of various approaches. Te reduction in both FBG and HbA1c% levels due to the provision of PC in this study is consistent with two randomized controlled clinical trials, in which the provision of PC resulted in a signifcant reduction in both FBG and HbA1c levels compared to the control group patients [31,38]. ...
Background. Management of diabetic neuropathy (DN) is a challenging issue. Terefore, integration of pharmaceutical care provided by the clinical pharmacists with pharmacotherapy may provide multifaceted approach to target the management of hyperglycemia and diabetic neuropathic complication. Tis study aimed to evaluate the efects of resveratrol (Resv) and/or pharmaceutical care (PC) on glycemic control and amelioration of diabetes-associated neuropathic complications. Patients and Methods. A four-arm randomized placebo-controlled clinical trial assigned 120 patients from the Diabetes and Endocrinology Center in Sulaymaniyah City, Iraq. Te patients were divided into four groups. Te Resv group (n � 30) received 500 mg Resv capsules once daily. Te Placebo group (n � 30) received placebo capsules. Resv + PC (n � 30) received Resv 500 mg capsules with PC. Placebo + PC (n � 30) received placebo capsule plus PC. Te duration of the intervention was 90 days. Drug therapy problems (DTPs) have been utilized as an important domain in PC. Clinical signs, symptoms, and neuropathic abnormalities were assessed using the Michigan Neuropathy Screening Instrument (MNSI), Douleur Neuropathique 4 (DN4) questions, and nerve conduction studies (NCSs) of the lower-limb sensory and motor nerves. Results. 97 patients from all the groups completed the study. At baseline, 84% of the Resv, 87% of the Placebo, and 92% of each of Resv + PC and Placebo + PC groups, respectively, had at least one DTP. Te provision of PC resulted in a dramatic reduction in the number of DTP. Resveratrol with PC signifcantly ameliorated hyperglycemic status, neuropathic signs, and symptoms, as evidenced by a decrease in MNSI and DN4 scores and improvement in electroneurographic parameters. Conclusion. Tese fndings support the integration of the PC concept into a pharmacotherapy intervention; they also encourage supplementation of Resv with conventional diabetes therapy to emphasize on the importance of this herbal medicine with the provision of PC in the management of diabetes and its neuropathic complications. Tis trial is registered with NCT05172947.
... Some studies conducted by clinical pharmacists to evaluate the impact of a pharmacist's education on medication adherence using the Morisky scale as a tool for adherence assessment found that the adherence in the interventional group at the end of the study was significantly improved compared to the control group (p < 0.01) [33,34]. In addition, Lee et al. also showed that medication adherence assessed by the Morisky scale was improved after an educational program conducted by clinical pharmacists [35]. ...
Background: Continuous therapeutic care with good medication adherence is the cornerstone of management of all chronic diseases including diabetes. This study aimed to evaluate the impact of clinical pharmacist intervention on the medication adherence in individuals with type 2 diabetes (T2DM). Methods: This was a randomized, double-blind, controlled trial conducted at a diabetes clinic located at Omdurman Military Hospital, Sudan. Individuals with T2DM attending the diabetes clinic within 1 year were selected. The sample size was 364 participants (182 control and 182 interventional group). We used a pre-structured standardized questionnaire and checklist to collect the data. Data were analyzed by using the Statistical Package for the Social Sciences (SPSS) (version 28). Results: Majority, 76.4% (n = 278) were females, and they consisted of 80.8% (n = 147) of the interventional group and 72% of the controls. The mean age of the interventional group was 54.5 (±10) years; 31.9% (n = 58) of the interventional group had diabetes for 6–10 years, compared with 26.4% (n = 48) of the control group. Among the control group, the mean adherence score was 6.8 (±1.7) at baseline and it was 6.7 (±1.6) at the end of the study (p < 0.001), while in the interventional group, the mean adherence score was 6.8 (±1.7) at baseline and it was 7.4 (±1.5) at the end of the study (p < 0.001). Conclusion: Adherence score among the intervention group was increased significantly from baseline to the end of the study when compared to the control group.
... Por esta razón, factores como el conocimiento del paciente sobre su medicación, sobre su enfermedad, la percepción del paciente sobre la necesidad de controlar la enfermedad y de la importancia del tratamiento, tener miedo a los efectos secundarios de los medicamentos o el olvido en la toma de los medicamentos no se ha visto reflejado en este trabajo. Además, se descartaron dos ensayos clínicos controlados aleatorizados (ECAs) debido a la falta de datos publicados (45) o por no mostrar medidas de asociación o riesgo (46) . Esto pudo haber generado sesgos de publicación. ...
Introducción: La adherencia al tratamiento antidiabético oral (ADO) en pacientes con Diabetes mellitus tipo 2 (DM2) se encuentra lejos de alcanzar las cifras deseables. Hay publicados multitud de trabajos que señalan factores que disminuyen la adherencia pero emplean distintas poblaciones y metodologías. Por tanto, el objetivo de esta revisión sistemática fue identificar y recopilar los factores que afectan a la falta de adherencia al tratamiento ADO en pacientes con DM2. Método: Las bases de datos utilizadas en la búsqueda bibliográfica fueron Medline (PubMed), Scopus, CINAHL y PsycINFO. Se consideraron estudios de casos-control, cohortes y ensayos clínicos aleatorizados realizados en personas con DM2 y tratamiento ADO, donde se evaluaran factores determinantes de adherencia. El proceso de revisión fue realizado por dos investigadores de manera independiente en base a las recomendaciones Prisma. Resultados: De 11 publicaciones seleccionadas, dos fueron estudios de casos-control y nueve estudios de cohortes (siete retrospectivos). Las cifras de falta de adherencia oscilaron entre el 20,3-48 %. Resultaron factores asociados a la falta de adherencia a los ADOs: copago del paciente, dosis diaria de ADO, tipo de ADO prescrito, número de medicamentos prescritos, menor frecuencia de citas con el personal sanitario, niveles altos de HbA1C, depresión, sexo femenino, raza/etnia (distinta de la blanca), estado civil (distinto del matrimonio) y edad. Conclusiones: Desde un punto de vista clínico, es importante identificar qué factores de riesgo son modificables y así, los profesionales sanitarios podrán diseñar acciones para que los pacientes mejoren su adherencia al tratamiento ADO y el control de la DM2.
... As a result, we investigated 21.2% of research that examined the role of a clinical pharmacist or a pharmacist in managing, regulating, and enhancing a patient's health. Clinical pharmacists/ pharmacists have a considerable impact on monitoring and maintaining clinical parameters of diabetic patients, according to 8.3% of studies in the field [37][38][39][40][41][42][43][44]. Respectively, we found that 6.8% of the studies focused on the positive role of pharmacists/ clinical pharmacists in different diseases such as metabolic syndrome, Poly Cystic Ovary Syndrome (PCOS), iron deficiency anemia and others [45][46][47][48][49][50][51][52][53]. ...
Introduction
Pharmaceutical care services (PCs) have evolved significantly over the last few decades, with a greater focus on patient’s safety and proven effectiveness in a wide range of contexts. Many of the evidence supporting this technique comes from the United States, the evaluation and adoption of (PCs) which differ greatly across the globe.
Objective
The goal of this study was to identify and assess the efficacy of pharmaceutical care services in various pharmaceutical aspects throughout seventeen Middle Eastern nations.
Method
The Arkesy and O’Malley technique was used to conduct a scoping review. It was conducted using PubMed/Medline, Scopus, Cochrane Library, Springer Link, Clinical Trials, and Web of Science etc. The Van Tulder Scale was utilized in randomized trials research, whereas the dawn and black checklists were used in non-randomized trials research. A descriptive and numerical analysis of selected research was done. The scope of eligible PCs, pharmaceutical implementers, study outcomes, and quality were all identified by a thematic review of research.
Results
There were about 431,753 citations found in this study, and 129 publications were found to be eligible for inclusion after analysing more than 271 full-text papers. The study design was varied, with 43 (33.3%) RCTs and 86 (66.7%) n-RCTs. Thirty-three (25.6%) of the studies were published in 2020. Jordan, Saudi Arabia, and Turkey were home to the majority of the studies (25.6%, 16.3%, and 11.6%) respectively. Thirty-seven studies (19.7%) were concerned with resolving drug related problems (DRPs), whereas 27 (14.4%) were concerned with increasing quality of life (QOL) and 23 (12.2%) with improving drug adherence. Additionally, the research revealed that the average ratings of the activities provided to patients improved every year.
Conclusion
Studies in the Middle East continue to provide evidence supporting the positive impact of pharmaceutical care services on both hard and soft outcomes measured in most studies. Yet there was rare focus on the value of the implemented services. Thus, rigorous evaluation of the economic impact of implemented pharmaceutical care services in the Middle East and assessment of their sustainability is must.
... . Penyakit yang sering menjadi penyebab utama pada peningkatan kasus kematian di seluruh dunia (Ranasinghe et al., 2018), serta penyakit dengan biaya pengobatan yang terus meningkat (Sharma et al., 2016). Di sejumlah negara maju, tingkat prevalensi standar DM dengan peningkatan glukosa darah puasa adalah 17,1% (Wishah et al., 2015). (Black & Hawks, 2014). ...
Diabetes Mellitus is a disease that can cause sufferers to lose physical function. The cases will continue to increase from year to year. If not treated immediately, diabetes can cause dangerous chronic conditions. Preventing complications through treatment such as medication and controlling blood glucose levels was needed. The study aimed to evaluate the effectiveness of single and combined physical exercises in reducing blood glucose levels in Type 2 DM patients. The literature review design used three international databases PubMed, ClinicalKey for Nursing, and the Cochrane Library. The literature review was performed on articles published between 2011 to 2022 using Randomized Control Trial designs. A total of nine articles met the inclusion criteria. Results showed that the single physical exercise intervention group and the combined physical exercise proved effective in reducing blood glucose levels compared to the control group. In addition, physical exercises also affect HbA1c, body mass, insulin levels, insulin resistance, adiponectin, IL-6, and short physical performance battery (SPPB). It can conclude through evidence-based studies that single or combined physical exercise interventions are proven to reduce blood glucose levels and HbA1c, also lowering the weight in type 2 DM sufferers. It is suggested to perform a specific review on physical exercises which are better in reducing the blood glucose level as well as other indicators.
... En cuanto al tipo de sesiones llevadas a cabo por los grupos de intervención, 22 estudios trabajaron con citas individuales únicamente, 5 estudios con sesiones grupales 16,34,35,37,38 y 3 estudios combinaron sesiones individuales y grupales 12,31,32 . Además 18 estudios realizaron sesiones presenciales, 1 estudio realizó únicamente sesiones vía telefónica 26 y 11 estudios combinaron sesiones presenciales con seguimientos por vía telefónica 9,14,15,17,21,22,[31][32][33]36,37 . ...
Introducción. La diabetes mellitus tipo 2, genera un incremento de riesgo de daño tanto a nivel microvascular como a nivel macrovascular, lo que da lugar a una disminución en la calidad de vida. En años recientes, ha habido numerosos esfuerzos por implementar intervenciones de atención farmacéutica, para mejorar el control y la progresión de esta enfermedad. Objetivo. Conocer el efecto de las intervenciones de Atención Farmacéutica en el control glicémico de pacientes ambulatorios con diabetes mellitus tipo 2. Metodología. Se realizaron búsquedas en Medline y en Cochrane Registro Central de Ensayos Controlados, para obtener ensayos controlados aleatorios que evaluaran la efectividad de las intervenciones de Atención Farmacéutica provistas por farmacéuticos: comunitarios, clínicos u hospitalarios, dirigidas a pacientes con diabetes mellitus tipo 2 a nivel ambulatorio, en comparación con la atención habitual. Resultados. En el grupo de intervención, la disminución en la diferencia media neta de hemoglobina glicosilada fue estadísticamente significativa en 27 estudios, el rango osciló entre: 0,4% y 3,3%; en 14 estudios dicha disminución fue estadísticamente significativa y superior o igual a 1%. En cuanto a la disminución en la diferencia media neta mostrada en el cambio de hemoglobina glicosilada, desde el inicio hasta el final del seguimiento, entre el grupo de intervención y el grupo control, fue significativa en 22 estudios y el rango osciló entre: 0,3 y 2,3%. Conclusión. Las evidencias recopiladas, demuestran el efecto significativo que tienen las intervenciones de Atención Farmacéutica en la mejora del control glicémico de pacientes ambulatorios con diabetes mellitus tipo 2.
... On the other hand, a difference of diurnal hyperglycemia during day phase between female compared to male and their matched control group was found. This observation could be related to a reduced metabolic control in our patients [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . Nevertheless, despite that, we determine the type, dose, and inoculation via of insulin that was delivered to the patients. ...
Daily glucose variability is higher in diabetic mellitus (DM) patients which has been related to the severity of the disease. However, it is unclear whether glycemic variability display a random or specific pattern of oscillation. Thus, to determine the glycemic variability pattern, we measured and analyzed continuous glucose monitoring (CGM) data, in controls and patients with DM type-1 (T1D). The CGM data were assessed for 6 days (day: 08:00–20:00-h; and night: 20:00–08:00-h). Participants (n=172; age=18-80 years) were assigned to T1D (n=144, females=65) and Control (i.e., healthy; n=28, females=22) groups. Anthropometry, pharmacologic treatments, glycosylated hemoglobin (HbA1c) and years of evolution were determined. T1D females displayed a higher glycemia at 10:00–14:00-h vs. T1D males and Control females. DM patients display mainly stationary oscillations (deterministic), with circadian rhythm characteristics. The glycemia oscillated between 2 and 6 days. The predictive model of glycemia showed that it is possible to predict hyper and hypoglycemia (R2=0.94 and 0.98, respectively) in DM patients independent of their etiology. Our data showed that glycemic variability had a specific oscillation pattern with circadian characteristics, with episodes of hypoglycemia and hyperglycemia at day phases, which could help therapeutic action of this population
... Non-pharmacological inter ventions included assessment, monitoring, lifestyle education, and counselling for the management of diabetes. The interventions were delivered by pharmacists (n=16 [35%]), 41 51,60 Of the 46 trials, 37 (80%) delivered a non-pharmacological intervention, eight (17%) had both non-pharmacological and pharmacological components, 38,40,42,44,52,61,66,69 and one (2%) 33 19 (41%) of the interventions were organised as individual sessions, 14 (30%) had group sessions, and seven (15%) had a mixture of both group and individual sessions. The format of intervention sessions was not described in six (13%) studies. ...
Background
Task-sharing interventions using non-physician health-care workers might be a potential diabetes management strategy in health systems that are constrained by physician shortages, such as those in low-income and middle-income countries (LMICs).
Methods
We did a systematic review and meta-analysis of task-sharing intervention strategies for managing type 2 diabetes in LMICs. We searched PubMed, Embase, and CINAHL from database inception to Sept 25, 2019, for studies that were randomised control trials or cluster randomised trials with task-shifted or task-shared interventions delivered to adults (≥18 years) by non-physician health workers versus usual care, done in LMICs with glycated haemoglobin (HbA1c) or fasting blood sugar (FBS) as outcome measures. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Random-effects model meta-analysis was used to estimate the population average pooled mean difference for HbA1c and FBS with 95% CIs. Our study protocol was registered in the PROSPERO database (CRD42018081015).
Findings
We found 4213 studies from the literature search, of which 46 (1·1%) were eligible for the narrative synthesis, including a total of 16 973 participants. 16 of these studies were excluded from the meta-analysis due to high risk of bias. 24 studies with a total of 5345 participants were included in the meta-analysis of HbA1c and 18 studies with a total of 3287 participants for FBS. Interventions led to an average reduction in HbA1c when tasks were delivered by nurses (averaged pooled mean difference −0·54% [95% CI −0·89 to −0·18]; I²=80%) and pharmacists (−0·91% [–1·15 to −0·68]; I²=58%), but not when they were delivered by dietitians (−0·50% [–1·10 to 0·09]; I²=54%) or community health workers (0·05% [0·03 to 0·07]; I²=0%). A reduction in average FBS was also observed when interventions were delivered by pharmacists (average pooled mean difference −36·26 mg/dL [–52·60 to −19·92]; I²=78%) but not nurses (−7·46 mg/dL [–18·44 to 3·52]; I²=79%) or community health workers (−5·41 [–12·74 to 1·92]; I²=71%). Only one study reported on FBS when tasks were delivered by dietitians, with a mean difference of −35·00 mg/dL (−65·96 to −4·04).
Interpretation
Task sharing interventions with non-physician healthcare workers show moderate effectiveness in diabetes management in LMIC settings. Although relatively high heterogeneity limits the interpretation of the overall findings, interventions led by pharmacists and nurses in LMICs with relatively high physician density are effective strategies in the management of diabetes.
Funding
Wellcome Trust–Department of Biotechnology India Alliance.
... Unlike the DIAB-CH program, in most of the published studies, educational intervention was performed either by the pharmacist alone (Doucette et al., 2009;Jarab et al., 2012;Jahangard-Rafsanjani et al., 2015;Wishah et al., 2015), or by a multidisciplinary healthcare team, including nurses, physicians, dieticians and pharmacists (Kang et al., 2010;Taveira et al., 2010;Cohen et al., 2011;Bukhsh, Tan, et al., 2018). The effectiveness of multidisciplinary collaboration on HbA1c reduction and diabetes control in primary care has already been highlighted (Kiel and McCord, 2005;Farland et al., 2013). ...
Background
International guidelines on diabetes control strongly encourage the setting-up of therapeutic educational programs (TEP). However, more than half of the patients fail to control their diabetes a few months post-TEP because of a lack of regular follow-up by medical professionals. The DIAB-CH is a TEP associated with the follow-up of diabetic patients by the community pharmacist.
Aim
To compare the glycated hemoglobin (HbA1c) and body mass index (BMI) in diabetic patients of Control (neither TEP-H nor community pharmacist intervention), TEP-H (TEP in hospital only) and DIAB-CH (TEP-H plus community pharmacist follow-up) groups.
Methods
A comparative cohort study design was applied. Patients included in the TEP-H from July 2017 to December 2017 were enrolled in the DIAB-CH group. The TEP-H session was conducted by a multidisciplinary team composed of two diabetologists, two dieticians and seven nurses. The HbA1c level and the BMI (when over 30 kg/m ² at M0) of patients in Control ( n = 20), TEP-H ( n = 20) and DIAB-CH ( n = 20) groups were collected at M0, M0 + 6 and M0 + 12 months. First, HbA1c and BMI were compared between M0, M6 and M12 in the three groups with the Friedman test, followed by the Benjamini-Hochberg post-test. Secondly, the HbA1c and BMI of the three groups were compared at M0, M6 and M12 using the Kruskal-Wallis test.
Findings
While no difference in HbA1c was measured between M0, M6 and M12 in the Control group, Hb1Ac was significantly reduced in both TEP-H and DIAB-CH groups between M0 and M6 ( P = 0.0072 and P = 0.0034, respectively), and between M0 and M12 only in the DIAB-CH group ( P = 0.0027). In addition, a significant decrease in the difference between the measured HbA1c and the target assigned by diabetologists was observed between M0 and M6 in both TEP-H and DIAB-CH groups ( P = 0.0072 and P = 0.0044, respectively) but only for the patients of the DIAB-CH group between M0 and M12 ( P = 0.0044). No significant difference ( P > 0.05) in BMI between the groups was observed.
Conclusion
The long-lasting benefit on glycemic control of multidisciplinary group sessions associated with community pharmacist-led educational interventions on self-care for diabetic patients was demonstrated in the present study. There is thus evidence pointing to the effectiveness of a community/hospital care collaboration of professionals on diabetes control in primary care.
... This non-adherence may complicate the disease's progression, raise the chances of comorbidity, invite expensive health management and lead to death. 33 53,54 A common approach is to combine an educational with a behavioural strategy to optimise the use of oral hypoglycaemic medications. 2,9,56,58 With 54.5% of type 2 diabetes patients in the current study not fully adhering to oral hypoglycaemic medication adherence, support services may be warranted in the study DHB. ...
INTRODUCTIONPoor adherence to oral hypoglycaemic medicines is a key contributor to therapy failure and sub-optimal glycaemic control among people with type 2 diabetes. It is unclear how commonly non-adherence to oral hypoglycaemics occurs in the general population. This information is essential to design and implement local adherence strategies. AIMThis study aimed to determine levels of sub-optimal adherence and identify patient groups who may need additional adherence support. METHODS
The dispensing data of 340,283 patients from one District Health Board was obtained from the Pharmaceutical Collection Database for the period 2008–15. Of these, 12,405 patients received oral hypoglycaemic therapy during the study period. The proportion of days covered (PDC) was calculated for patients with complete data and a PDC value of ≥80% was used to indicate sufficient adherence. Patient demographics (gender, ethnicity, age, socioeconomic status) and therapy type (mono- or combination) were described. RESULTSOverall, 54.5% of the patients were found to have a PDC of <80% and so were considered non-adherent. Non-adherence was significantly higher in patients receiving combination oral hypoglycaemic therapy than monotherapy; in male patients; in New Zealand Māori patients; and in patients with higher socioeconomic deprivation. DISCUSSIONIn the study region, non-adherence to oral hypoglycaemic medicines was significant and widespread. Identification of such patients is important so that strategies to enhance adherence can be implemented. Prescribers need to be encouraged to optimise monotherapy before the addition of another oral hypoglycaemic, and adherence support services should be offered not only to older patients.
... 29 Clinical outcomes like HbA1c, FBG, and lipid profiles, as well as medication adherence, diabetes knowledge, and diabetes self-care activities improved among T2DM intervention patients in Jordan due to the introduction of printed leaflets about diabetes medications. 30 Tailored diabetes education leads to sustained improvement in HbA1c and diabetes knowledge in comparison to usual care. 31 A meta-analysis of RCTs reported significant reductions in HbA1c, BP, and TG levels among diabetic patients by use of consumer health information technologies (CHITs) compared to usual care. ...
Background:
The importance of providing accurate medication information that can be easily comprehended by patients to subsequently best use their medication(s) has been widely reported in the literature. Patient information leaflet (PIL) is a supporting tool aiding patients to make decisions about their treatment plan and improve patient-clinician communication and thus medication adherence. PIL is the written document produced by the pharmaceutical manufacturers and packed with the medicine. The available PILs do not consider cultural and behavioral perspectives of diverse populations residing in a country like Qatar. Consumer medication information (CMI) is written information about prescription drugs developed by organizations or individuals other than a drug's manufacturer that is intended for distribution to consumers at the time of drug dispensing.
Objective:
To investigate the impact of customized CMI (C-CMI) on health-related quality of life (HRQoL) among type 2 diabetes mellitus (T2DM) patients in Qatar.
Methods:
This was a randomized controlled intervention study, in which the intervention group patients received C-CMI and the control group patients received usual care. HRQoL was measured using the EQ-5D-5L questionnaire and EQ visual analog scale (EQ-VAS) at three intervals [i.e. baseline, after 3 months and 6 months].
Results:
The EQ-5D-5L index value for the intervention group exhibited sustained improvement from baseline to the third visit. There was a statistically significant difference between groups in the HRQoL utility value (represented as EQ index) at 6 months (0.939 vs. 0.796; p = 0.019). Similarly, the intervention group compared with the control group had significantly greater EQ-VAS at 6 months (90% vs. 80%; p = 0.003).
Conclusions:
The impact of C-CMI on health outcomes of T2DM patients in Qatar reported improvement in HRQoL indicators among the intervention patients. The study built a platform for health policymakers and regulatory agencies to consider the provision of C-CMI in multiple languages.
Background
Health care providers are mandated to deliver specialized care for the treatment and control of type 2 diabetes mellitus. In Malaysia, Diabetes Medication Therapy Adherence Clinics (DMTAC) in tertiary hospitals have designated pharmacists to administer these services.
Objective
To assess the effects of pharmacist-led interventions within DMTAC on the outcomes of patients with type 2 diabetes mellitus in two distinct hospitals in Kedah, Malaysia.
Methods
Patients with type 2 diabetes were randomly selected from the two hospitals included in this study. The study population was divided into two equal groups. The control group consisted of 200 patients receiving routine care from the hospitals. On the other hand, the intervention group included those patients with type 2 diabetes (200), who received separate counseling sessions from pharmacists in the DMTAC departments along with the usual treatment. The study lasted 1 year, during which both study groups participated in two distinct visits.
Results
Parametric data were analyzed by a paired t-test and one-way ANOVA, while non-parametric data were analyzed by a Chi-squared test using SPSS v24. A p < 0.05 was considered statistically significant. The study presented the results of a greater reduction in HBA1c levels in the intervention group compared to the control group, i.e., 3.59 and 2.17% (p < 0.001). Moreover, the Systolic and Diastolic values of BP were also significantly reduced in the intervention group, i.e., 9.29 mmHg/7.58 mmHg (p < 0.005). Furthermore, cholesterol levels were significantly improved in patients in the intervention group, i.e., 0.87 mmol/L (p < 0.001).
Conclusion
Based on the findings of the current study it has been proven that the involvement of pharmacists leads to improved control of diabetes mellitus. Therefore, it is recommended that the government initiate DMTAC services in both private and government hospitals and clinics throughout Malaysia. Furthermore, future studies should assess the impact of pharmacist interventions on other chronic conditions, including but not limited to asthma, arthritis, cancer, Alzheimer’s disease, and dementia.
O diabetes mellitus é um grupo de doenças metabólicas crônicas, caracterizado pelo aumento da glicemia dos portadores, sendo uma importante causa de mortalidade e morbidade, podendo, também, ter repercussões econômicas e sociais. Sabendo que a prática da atenção farmacêutica tem se mostrado muito importante na adesão e acompanhamento, proporcionando o uso seguro e racional de medicamentos, o objetivo deste trabalho foi realizar uma revisão de literatura sobre os estudos que impactam a atenção farmacêutica no manejo de pacientes diabéticos. Todos os estudos apontaram resultados positivos acerca da atenção farmacêutica à esse grupo de pacientes, com melhoras clínicas (redução da glicemia, HbA1c, pressão arterial, perfil lipídico), psicossociais e econômicas. Notando-se melhoras significativas na adesão ao tratamento antidiabético, a pesquisa visa cooperar para com a melhora dos resultados clínicos de pacientes desse grupo.
Background:
There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations.
Objectives:
To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care.
Search methods:
We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section.
Selection criteria:
We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy.
Data collection and analysis:
We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available.
Main results:
We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other).
Authors' conclusions:
There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
This scoping review aimed to map the extent and range of evidence on the clinical activities performed and types of outcomes evaluated in pharmacist‐involved collaborative care models for diabetes management. This scoping review was guided by the 5‐stage methodological framework developed by Arksey and O'Malley. Publications in the English language were identified from PubMed, EMBASE, and CINAHL and the databases were searched from inception to May 31, 2022. Abstracts, conference proceedings, brief reports, and commentaries were excluded. Key search terms included “interprofessional collaborative care”, “pharmacist”, “type 2 diabetes” and “outcome”. Microsoft Excel was used for data charting and descriptive computations were conducted using the Statistical Package for Social Sciences. A total of 208 articles were identified, and after excluding 178 articles (and duplicates), 30 articles were reviewed. Most of the studies (56.7%) were conducted in the United States of America and were randomized controlled trials (50.0%) followed by cohort studies (36.7%). The most common clinical activity identified was provision of health‐ and medication‐related education (80.0%), followed by lifestyle counselling (76.7%) and development of individualized care plan and goal setting (63.3%). Other clinical activities included review of laboratory records, medication review and dose adjustments, optimization of medication adherence, minimization of drug‐related problems, identify referral to other care providers, and conduct physical assessments. HbA1c was the most reported clinical outcome (n = 26, 86.7%), with 11 studies evaluating patient‐reported outcomes such as medication adherence, diabetes knowledge, self‐care, quality of life, diabetes distress, and treatment satisfaction. Clinical activities performed by pharmacists were heterogenous across studies and based on patients' needs. While pharmacist‐involved collaborative care models were posited as person‐centric, patient‐reported outcomes were lacking in most studies. Evaluating patient‐reported outcomes are essential in guiding the implementation of such people‐centric care models. This article is protected by copyright. All rights reserved.
In response to the growing concern over diabetes, state-mandated health insurance benefits for diabetes have become popular since the late 1990s. However, little is known about whether these mandates improve the health of people with diabetes. In this paper, I use data from the restricted-use Multiple Cause of Death Mortality database and the Behavioral Risk Factor Surveillance System to investigate the effects of these mandates on diabetes-related mortality rates, along with the underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that approximately 3.1 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements. These findings can inform the ongoing policy debate on strengthening or weakening coverage mandates, including Essential Health Benefits under the Affordable Care Act.
Background: Pharmaceutical care is a patientoriented program carried out by pharmacists. In the management of type 2 diabetes mellitus (T2DM) several parameters have been determined as targets for the success of pharmaceutical care such as HbA1c and the level of patient compliance. This paper aims to evaluate the role of pharmaceutical care in improving clinical outcomes and compliance of patients with T2DM.
Subjects and Method: This study was conducted using a Systematic Review and Metaanalysis study design using PICO, population: Diabetes mellitus type 2 patients, Intervention: Obtaining pharmaceutical care. Comparison: Did not receive pharmaceutical care, Outcome: Hba1c. The articles used in this study came from 4 databases, namely Pubmed, ScienceDirect, ProQuest and Google scholar. Article keywords are Diabetes Mellitus, Type 2 OR T2DM OR Type 2 diabetes AND Pharmaceutical care OR Clinical pharmacy OR Community pharmacy OR Pharmacist* OR Pharmaceutical services OR Education OR Intervention OR Medication Management AND Knowledge OR adherence OR HbA1c OR glycemic control” Included articles in this study is a full paper article, RCT study design for 20112021.
Results: A total of 12 RCT studies with 1,746 T2DM patients in Asia (Jordan, Hong Kong, Northern Cyprus, Thailand, China, Malaysia and Indonesia), Americas (Brazil) and Europe (France and England). From the data processing, it was found that the provision of pharmaceutical care reduced HbA1c levels by 0.81 in patients with type 2 diabetes mellitus compared to those without pharmaceutical care. (SMD= 0.81; 95% CI= 1.11 to 0.52 p
This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: −0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
Introduction: Epidemiological studies have reported that diabetes-related complications increase after 5 years of uncontrolled/suboptimal metabolic control. The risk of experiencing diabetes-related microvascular diseases usually spike after 10 years of uncontrolled diabetes. Objectives: The objective of this study was to evaluate the impact of team-based pharmaceutical care on glycemic control, self-care, diabetes-dependent quality of life, and productivity loss in patients with long-standing diabetes (≥5 years). Methods: This was a prospective, multicenter, randomized, controlled study. Patients with a glycosylated hemoglobin (HbA1c) > 7%, long-standing diabetes defined as having a disease duration of at least 5 years, and polypharmacy defined as taking 5 or more chronic medications were included in the study. Patients in the intervention arm received team-based pharmaceutical care regularly while patients in the control arm received physician-centered care. Patients' humanistic outcomes were followed for 6 months. Results: A total of 248 patients (126 intervention and 122 control) were included in the study. In addition to improved glycemic control observed in the intervention arm (mean difference: 0.44%, P =.003, 95% confidence interval: [0.15, 0.73]), the intervention arm showed significant improvements in overall self-care level (+0.36, 95% confidence interval: [0.01, 0.72], P =.045) and self-monitoring of blood glucose (+1.87, 95% confidence interval: [1.00, 2.99], P <.001) compared with the control arm. There were no significant differences in the changes in diabetes-associated quality of life and overall work impairment between the two arms. A significant difference in activity impairment (affected productivity in regular unpaid activity) between the two arms was found, with 43.3% impairment having occurred in the control group vs 27.9% in the intervention group (P =.047). Conclusion: Team-based pharmaceutical care significantly improved overall self-care and glycemia without deteriorating quality of life and incurring productivity loss. Our findings highlighted the value of team-based pharmaceutical care in managing diabetes-experienced patients.
Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting in Qatar using real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS®. Glycemic control (glycated hemoglobin A1c, HbA1c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA1c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), and body mass index (30.42 kg/m2 vs. 30.17 kg/m2) after 17 months within the intervention group. However, no significant changes for these parameters occurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17 months. Future studies should determine the long-term impact of this care model.
Objective
To evaluate the effect of a medication assistance program and the addition of pharmacist management on clinical outcomes in patients with hypertension and diabetes through an Advanced Pharmaceutical Care program.
Methods
This was a prospective quality improvement study on patients with hypertension and/or diabetes resistant to usual care. The primary outcomes were change in A1C, blood glucose, and blood pressure between 3 phases: usual care, free medications, and free medications plus pharmacist management. Secondary outcomes included achievement of A1C, blood glucose, and blood pressure goals as well as pharmacist interventions.
Results
Seven patients were included in the study. The mean A1C decreased from 11.3% to 8.3% with free medications (p = 0.28) and from 8.3% to 6.4% with pharmacist management (p = 0.119). Mean blood pressure during usual care, free medications, and pharmacist intervention was 150/87 mm Hg, 148/85 mm Hg, and 125/78 mm Hg, respectively. After pharmacist management, 75% of patients with type 2 diabetes were able to achieve A1C and blood glucose goals, and 71% of patients with hypertension achieved blood pressure <130/80 mm Hg.
Conclusions
The Advanced Pharmaceutical Care program allowed pharmacists to identify and overcome patient-specific barriers to care, provide individualized disease state education, and optimize medication management. Medication assistance led to improvements in A1C and blood pressure, but did not affect achievement of disease state goals. Pharmacist involvement in hypertension and diabetes care led to clinically significant reductions in blood pressure and A1C and enabled patients to reach guideline-recommended blood pressure and glycemic goals.
Aim
To examine the effectiveness of clinical pharmacy interventions on health and economic outcomes of patients with type 2 diabetes in hospital settings.
Methods
We searched MEDLINE, EMBASE, PsycInfo, CINAHL, COCHRANE Library, and citations and reference lists of key articles. We included randomized and non‐randomized controlled trials, cohort, and controlled before‐after studies. Primary outcomes were glycosylated hemoglobin (HbA1c), all‐cause mortality, major cardiovascular events, adverse events, health‐related quality of life, and economic outcomes.
Results
We retrieved 11,853 studies, of which 44 studies were included in the review (n=8,623). We included 29 randomized controlled studies in the meta‐analyses (n=4,055). Clinical pharmacy interventions significantly reduced HbA1c levels compared to usual care; standardized mean difference (SMD): ‐0.52, P<0.001). The interventions significantly reduced adverse events compared to usual care. No studies were reported on the effectiveness of clinical pharmacy interventions on major cardiovascular events. In one study that examined the impact of clinical pharmacy interventions on all‐cause mortality, a non‐significant reduction was observed compared with usual care. There was significant improvement in quality of life and significant reduction in costs of type 2 diabetes care compared to usual care.
Conclusions
Clinical pharmacy interventions were effective in improving glycemic control, quality of life, and reduced the rate of adverse events and costs of type 2 diabetes care.
Objectives
To elicit patients’ preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia.
Methods
A discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis.
Results
Respondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments.
Conclusion
Differences in patients’ preferences identified in the study provide information on pharmacist services that meet patients’ expectations and contribute to improve medication management among people with diabetes.
Practice implication
This study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.
O diabetes mellitus é uma doença crônica responsável por inúmeras complicações que comprometem a qualidade de vida dos pacientes, sendo necessário para prevenção a adoção de medidas educativas que enfatize a importância do autocuidado e da adesão ao tratamento. Objetivo deste artigo é descrever as ações realizadas e os resultados alcançados com a implementação do Serviço de Orientação Sobre o Uso de Insulina (SOSUI). Trata-se de um estudo observacional, realizado no período de agosto de 2014 a fevereiro de 2015. Foram selecionados pacientes diabéticos insulinizados, sendo eles idosos e adultos frágeis submetidos à amputação devido a comprometimento de pé diabético. O SOSUI foi constituído em duas fases, sendo uma no período da internação hospitalar (pré-alta), e a segunda no período pós-alta hospitalar. No período pré-hospitalar, farmacêuticos vinculados a um programa de residência multiprofissional realizaram uma abordagem entre os pacientes, seguida de treinamentos práticos individualizados sobre a administração da insulina. Passado um período mínimo de quatro meses após a alta hospitalar, foi realizada interação mediada por telefone com o intuito de identificar mudanças nos relatos dos pacientes em relação ao uso da insulina, assim como melhora nos valores glicêmicos. Os dados foram registrados no programa Microsoft Excel, seguido de análise univariada. Foram 17 pacientes elegíveis para o estudo, com idade média de 63 anos, sendo 76,47% do sexo masculino e 23,53% do sexo feminino. O tempo médio de internação foi de 21 dias. Em relação ao perfil glicêmico dos participantes, observa-se que houve melhora nos níveis de glicemia de jejum e hemoglobina glicada dos pacientes orientados pelo serviço, e que estavam sob os cuidados da Atenção Primária. Além de melhoras nos relatos sobre técnicas de homogeneização e administração da insulina, foi evidenciada entre os pacientes uma hemoglobina glicada média de 9,97%, sendo esse valor médio reduzido para 7,0% após a alta hospitalar. Isso indica melhora do controle glicêmico pelos pacientes, o que pode ser influenciado pelas experiências de adoecimento, internação e amputação decorrente de complicações do diabetes, associadas ao fato de os pacientes terem também recebido orientações educacionais sobre o uso da insulina, favorecendo melhor entendimento sobre o uso desse medicamento. A implementação do SOSUI serviu como importante ferramenta no processo de educação em saúde sobre o diabetes para os pacientes acompanhados pelo Serviço de Farmácia Clínica, proporcionando melhora no gerenciamento da farmacoterapia com insulina; melhor conhecimento sobre o diabetes e suas complicações; e para a importância da adesão ao tratamento.
Background
Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs.
Methods and findings
We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was −0.46% (95% CI −0.60% to −0.31%, I² 87.8%, p < 0.001) overall, −0.37% (95% CI −0.64% to −0.10%, I² 60.0%, n = 7, p = 0.020) in multicomponent clinic-based interventions, −0.87% (−1.20% to −0.53%, I² 91.0%, n = 13, p < 0.001) in pharmacist task-sharing studies, and −0.27% (−0.50% to −0.04%, I² 64.1%, n = 7, p = 0.010) in trials of diabetes education or support alone. Other types of interventions had few included studies. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. The certainty of evidence for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types. Limitations include the lack of consensus definitions for health system interventions, differences in the quality of underlying studies, and sparse data availability for non-glycemic outcomes.
Conclusions
In this meta-analysis, we found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies are available from rural areas or low- or lower-middle-income countries. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings.
Introduction
In patients with diabetes, better health communication is associated with better health outcomes including medication adherence and glycemic control. The conventional patient information leaflet does not consider cultural and behavioral perspectives of diverse patient populations. Consumer medicine information (CMI) is a written information about prescription drugs developed by organizations or individuals other than a drug’s manufacturer that is intended for distribution to consumers at time of medication dispensing.
Objective
This study aimed to evaluate the impact of CMI on medication adherence and glycemic control among patients with diabetes in Qatar.
Methods
We developed and customized CMI for all the anti‐diabetic medications used in Qatar. A randomized controlled trial in which the intervention group patients (n=66) received the customized CMI with usual care, while the control group patients (n=74) received usual care only, was conducted. Self‐reported medication adherence and hemoglobin A1c (HbA1c) were the primary outcome measures. Glycemic control and medication adherence parameters were measured at baseline, 3 months, and 6 months in both groups. Medication adherence was measured using 8‐item Morisky Medication Adherence Scale (MMAS‐8).
Results
Although the addition of CMI resulted in better glycemic control, this did not reach statistical significance, possibly due to short‐term follow‐up. The median MMAS‐8 score improved from baseline (6.6 [IQR=1.5]) to 6‐month follow‐up (7.0 [IQR=1.00]) in the intervention group. In addition, there was a statistically significant difference between the intervention and control groups in terms of MMAS‐8 score at the third visit [7.0 (IQR=1.0) vs. 6.5 (IQR=1.25; p‐value= 0.010).
Conclusion
CMI for anti‐diabetic medications when addedd to usual care has the potential to improve medication adherence and glycemic control among patients with T2DM. Therefore, providing better health communication and CMI to patients with T2DM is recommended.
Background
Clinical practice guidelines recommend team-based care as one strategy to improve dyslipidemia outcomes. Randomized controlled trials (RCTs) have demonstrated that pharmacist interventions reduce low-density lipoprotein cholesterol (LDL-C) levels.
Objective
To conduct a random effects meta-analysis to determine the effectiveness of pharmacist interventions on reducing LDL-C levels.
Methods
A literature search of RCTs published after January 1, 2000 was performed using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Included RCTs had to evaluate a pharmacist intervention compared to usual care, report baseline and follow-up LDL-C levels, and enroll at least 100 subjects. Mean differences in LDL-C and other lipid parameters were calculated using a random effects model.
Results
Twenty-six RCTs (n=22,095 patients) were included in the meta-analysis. Compared to usual care, pharmacist interventions significantly reduced LDL-C levels by -7.9 mg/dL (95% CI -11.43 to -4.35; I² = 94%). A subgroup analysis revealed a greater reduction in LDL-C (-13.73 mg/dL; 95% CI -24.07 to -3.40; I²=96%) when LDL-C was the sole primary outcome. Significant improvements in total cholesterol (-12.73 mg/dL, 95% CI -19.18 to -6.27), triglycerides (-13.25 mg/dL, 95% CI -26.10 to -0.41), and high-density lipoprotein cholesterol (1.75 mg/dL, 95% CI 0.03 to 3.46) were also found.
Conclusion
Pharmacist interventions significantly reduced LDL-C levels compared to usual care. Further research is warranted to determine the optimal pharmacist intervention for reducing LDL-C levels and to evaluate the comprehensive role of pharmacists in lipid management.
Background
Pharmacists‐led medication reviews ( MRs ) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta‐analysis was to analyze the impact of pharmacist‐led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs .
Methods and Results
Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist‐led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta‐analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CI s. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta‐analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05–7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17–5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05–3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low‐density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present.
Conclusions
Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities.
Aims:
Self-monitoring of blood glucose (SMBG) is an important self-care activity for patients with Type 2 diabetes mellitus (T2DM) to achieve glycaemic control. The aim of this study was to evaluate the impact of providing SMBG supplies on self-care among patients with uncontrolled T2DM.
Methods:
This was a six-month, prospective study conducted in two primary care institutions. Patients ≥21 years old with uncontrolled T2DM (HbA1c >7.0%) and polypharmacy (≥5 chronic medications) were included. All participants were given a free blood glucometer, test strips, and lancets, and were invited to consult pharmacists to learn about SMBG. The Summary of Diabetes Self-Care Activities questionnaire was administered at baseline and at six months.
Results:
A total of 167 patients were recruited and 150 (89.8%) completed the study. At six months, significant improvements from baseline were observed for overall self-care (+0.58, p=0.008), glycemic control (-0.41%, p<0.001) and all specific self-care activities. The mean change in the SMBG score in all the participants was found to have a strong positive correlation with the mean change in the overall self-care score (rs=0.580, p=0.01).
Conclusions:
Provision of SMBG supplies was effective in improving self-care among patients with uncontrolled T2DM, including non-insulin-treated patients.
OBJECTIVES: Evaluate a community pharmacist-based diabetes patient-management program by examining the pharmacists' impact on five intermediate outcomes: glycosolated hemoglobin (HbA1c), blood pressure, body mass index, lipid levels, and medication use in patients with diabetes.
SETTING: A network of community pharmacies in West Virginia and southeastern Ohio.
PATIENTS: The program was available to all patients with diabetes who attended the network pharmacies regardless of baseline glycemic control. Of the 47 patients initially enrolled, 32 stayed in the program for at least 6 months during the year-long study (median time in program was 9 months).
INTERVENTION: Pharmacists provided a basic, standardized diabetes education program during three 1-hour sessions. This was accompanied by a clinical assessment and a report to the patient's primary care physician. The patients met with the pharmacist every 3 months for continued monitoring. After each visit, the patient's primary care physician was sent a report along with recommendations for drug therapy modification when appropriate.
MAIN OUTCOME MEASURES: HbA1c, blood pressure, total cholesterol, low density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, body mass index, and the number of drug therapy modifications.
RESULTS: There was significant improvement in total cholesterol (t= 2.58, p=0.015) and LDL (t= 2.56, p=0.017) for the 32 participating patients. HbA1c, BMI, blood pressure, HDL and triglycerides did not change significantly across all patients. For a subgroup of 10 patients with baseline HbA1cgreater than8%, average HbA1c declined significantly from 9.8% to 8.6% (t= 3.00, p=0.015). During the study, the 32 patients had a total of 53 modifications to their medication regimens. The most common was a change in dose of oral diabetes medications.
CONCLUSIONS: The pharmacist-based diabetes patient-management program was associated with improvements in total cholesterol and LDL across all patients who maintained enrollment in the program for at least 6 months. Improvements in HbA1c were also demonstrated for a subgroup of patients who had poor glycemic control at baseline.
The objective of this study was to answer the following questions. How do community pharmacists in Jordan understand pharmaceutical care? What is the extent of pharmaceutical care practice in community pharmacies in Jordan? What are the main barriers to practising pharmaceutical care in Jordan? What is the attitude of community pharmacies in Jordan when considering provision of pharmaceutical care?
A questionnaire was hand delivered to a random sample of 310 community pharmacists. The questionnaire was composed of six different sections including patient demographics, pharmacists' understanding of pharmaceutical care, frequencies of practice of pharmaceutical care, pharmacists' general attitudes about pharmaceutical care, pharmacists' intentions to provide specific pharmaceutical care activities and barriers to providing pharmaceutical care. Frequencies, percentages, means and standard deviations were used to describe pharmacists' responses. Chi-square and regression analysis were also conducted to identify important associations.
More than 62% of respondents had a correct understanding of the basic concept of pharmaceutical care. The data show that the level of reported pharmaceutical care activities was limited. In general pharmacists have very good attitudes toward pharmaceutical care. Interestingly, more than 90% of respondents fully support the concept of pharmaceutical care. The need for pharmaceutical care training was found to be the top barrier to the provision of pharmaceutical care as indicated by more than 80% of pharmacists.
While pharmaceutical care provision is limited at this stage in Jordan, the responding pharmacists had a good understanding of pharmaceutical care. They expressed a willingness to implement pharmaceutical care practice but have identified a number of barriers to successful implementation. With the introduction of PharmD and Master of Clinical Pharmacy programmes, publication of the results of local studies on the benefit of pharmaceutical care, improved communications with physicians and modification of the current undergraduate pharmacy curriculum to include more focus on therapeutics and pharmaceutical care, many of these perceived barriers may be eliminated in the future.
This paper summarizes the outcomes associated with pharmacist involvement in diabetes care in all pharmacy practice settings. Published literature was identified through a search of MEDLINE (1960 to September, week 1, 2008) and International Pharmaceutical Abstracts using the search terms "pharmacist," "pharmaceutical care," and "diabetes mellitus." Only articles reporting clinical or behavior change outcomes were selected for review; papers written outside the United States and citations only in abstract form were not reviewed. The specific data extracted included the following: practice setting, model of care, roles of the pharmacist, study design, number of patients studied, duration of the evaluation, and documented outcomes such as changes in hemoglobin A(1c) values, adherence to standards of care (lipids, blood pressure, eye exams, foot exams, aspirin use), and changes in quality of life. The greatest improvements in hemoglobin A(1c) values tend to be observed when pharmacists work in collaborative practice models. Growing evidence demonstrates that pharmacists, working as educators, consultants, or clinicians in partnership with other health care professionals, are able to contribute to improved patient outcomes.
The American Association of Clinical Endocrinologists/American College of Endocrinology Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances.
This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center (IEMRC) from April 2008 to January 2009.
In a randomized controlled clinical trial, a total of 172 patients with uncontrolled type 2 diabetes were selected and randomly allocated into control and intervention groups. After taking informed written consent, the intervention group received an educational program about oral anti-hyperglycemic medications, adherence, diabetes dairy log and pill box usage. Patient's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist. Fasting blood glucose and HbA1c were measured at the start and end of the pharmacistled drug education program for both intervention and control groups.
After a three months follow-up, mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group (p < 0.001).
This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics. The results suggest the benefits of adding adherence education to the diabetic education programs.
To examine the influence of a pharmaceutical care programme on disease control and health-related quality of life in Type 2 diabetes patients in the United Arab Emirates.
A total of 240 Type 2 diabetes patients were recruited into a randomized, controlled, prospective clinical trial with a 12-month follow-up. A range of clinical measures, medication adherence and health-related quality of life (Short Form 36) were evaluated at baseline and up to 12 months. Intervention group patients received pharmaceutical care from a clinical pharmacist, whereas control group patients received their usual care from medical and nursing staff. The primary outcome measure was change in HbA(1c). British National Formulary and Framingham scoring methods were used to estimate changes in 10-year coronary heart disease risk scores in all patients.
A total of 234 patients completed the study. Significant reductions (P < 0.001) in mean values (baseline vs. 12 months; 95% confidence interval) of HbA(1c)[8.5% (8.3, 8.7) vs. 6.9% (6.7, 7.1)], systolic [131.4 mmHg (128.1, 134.7) vs. 127.2 mmHg (124.4, 130.1)] and diastolic blood pressure [85.2 mmHg (83.5, 86.8) vs. 76.3 mmHg (74.9, 77.7)] were observed in the intervention group; no significant changes were noted in the control group. The mean Framingham risk prediction score in the intervention group was 10.56% (9.7, 11.4) at baseline; this decreased to 7.7% (6.9, 8.5) (P < 0.001) at 12 months but remained unchanged in the control group.
The pharmaceutical care programme resulted in better glycaemic control and reduced cardiovascular risk scores in Type 2 diabetes patients over a 12-month period.
Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
To determine the reliability and the validity of the Diabetes Care Profile (DCP), an instrument that assesses the social and psychological factors related to diabetes and its treatment, two studies with separate populations and methodologies were conducted. In the first study, the DCP was administered to, and physiologic measures collected from, individuals with diabetes being cared for in a community setting (n = 440). In the second study, the DCP and several previously validated scales were administered to individuals with diabetes receiving care at a university medical center (n = 352). Cronbach's alphas of individual DCP scales ranged from .60 to .95 (Study 1) and from .66 to .94 (Study 2). Glycohemoglobin levels correlated with three DCP scales (Study 1). Several DCP scales discriminated among patients with different levels of disease severity. The results of the studies indicate that the DCP is a reliable and valid instrument for measuring the psychosocial factors related to diabetes and its treatment.
To review reliability, validity, and normative data from 7 different studies, involving a total of 1,988 people with diabetes, and provide a revised version of the Summary of Diabetes Self-Care Activities (SDSCA) measure.
The SDSCA measure is a brief self-report questionnaire of diabetes self-management that includes items assessing the following aspects of the diabetes regimen: general diet, specific diet, exercise, blood-glucose testing, foot care, and smoking. Normative data (means and SD), inter-item and test-retest reliability, correlations between the SDSCA subscales and a range of criterion measures, and sensitivity to change scores are presented for the 7 different studies (5 randomized interventions and 2 observational studies).
Participants were typically older patients, having type 2 diabetes for a number of years, with a slight preponderance of women. The average inter-item correlations within scales were high (mean = 0.47), with the exception of specific diet; test-retest correlations were moderate (mean = 0.40). Correlations with other measures of diet and exercise generally supported the validity of the SDSCA subscales (mean = 0.23).
There are numerous benefits from standardization of measures across studies. The SDSCA questionnaire is a brief yet reliable and valid self-report measure of diabetes self-management that is useful both for research and practice. The revised version and its scoring are presented, and the inclusion of this measure in studies of diabetes self-management is recommended when appropriate.
To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes.
Prospective observational study. Setting: 23 hospital based clinics in England, Scotland, and Northern Ireland. Participants: 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk.
Primary predefined aggregate clinical outcomes: any end point or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photo-coagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 1% reduction in updated mean HbA(1c) adjusted for possible confounders at diagnosis of diabetes.
The incidence of clinical complications was significantly associated with glycaemia. Each 1% reduction in updated mean HbA(1c) was associated with reductions in risk of 21% for any end point related to diabetes (95% confidence interval 17% to 24%, P<0.0001), 21% for deaths related to diabetes (15% to 27%, P<0.0001), 14% for myocardial infarction (8% to 21%, P<0.0001), and 37% for microvascular complications (33% to 41%, P<0.0001). No threshold of risk was observed for any end point.
In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia. Any reduction in HbA(1c) is likely to reduce the risk of complications, with the lowest risk being in those with HbA(1c) values in the normal range (<6.0%).
Low adherence with prescribed treatments is ubiquitous and undermines treatment benefits.
To systematically review published randomized controlled trials (RCTs) of interventions to assist patients' adherence to prescribed medications.
A search of MEDLINE, CINAHL, PSYCHLIT, SOCIOFILE, IPA, EMBASE, The Cochrane Library databases, and bibliographies was performed for records from 1967 through August 2001 to identify relevant articles of all RCTs of interventions intended to improve adherence to self-administered medications.
Studies were included if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications for a medical or psychiatric disorder; both adherence and treatment outcome were measured; follow-up of at least 80% of each study group was reported; and the duration of follow-up for studies with positive initial findings was at least 6 months. Information on study design features, interventions, controls, and findings (adherence rates and patient outcomes) were extracted for each article.
Studies were too disparate to warrant meta-analysis. Forty-nine percent of the interventions tested (19 of 39 in 33 studies) were associated with statistically significant increases in medication adherence and only 17 reported statistically significant improvements in treatment outcomes. Almost all the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, counseling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions had modest effects.
Current methods of improving medication adherence for chronic health problems are mostly complex, labor-intensive, and not predictably effective. The full benefits of medications cannot be realized at currently achievable levels of adherence; therefore, more studies of innovative approaches to assist patients to follow prescriptions for medications are needed.
In the U.S., a large percentage of patients with diabetes receive less than optimal care (1). The use of pharmacists, nurse practitioners, and multidisciplinary teams in a variety of settings have led to improvements in disease control in patients with diabetes and other chronic diseases (2–14). This report describes the utility of a pharmacist-run disease management program in improving the care of predominately indigent, Spanish-speaking patients with diabetes and common comorbid conditions.
The study was conducted at El Rio Health Center, which is a federally qualified health center located in Tucson, Arizona. The patient population is comprised mostly of indigent, Spanish-speaking, and sometimes transient patients with primarily type 2 diabetes. The program was implemented in August 2001, using a residency-trained, bilingual PharmD as the provider for patients referred to the pharmacist-based diabetes service by staff physicians. The pharmacist served as the primary care provider for the patients’ diabetes and comorbid conditions, hypertension, and hyperlipidemia. Using medical staff–approved collaborative practice agreements, the pharmacist provided appropriate diagnostic, educational, and therapeutic management services, including prescribing medication and ordering laboratory tests. The collaborative practice agreements were based on national …
There is limited information from randomized controlled studies about the influence of pharmacist interventions on diabetes control.
To evaluate the effect of a pharmacist intervention on improving diabetes control; secondary endpoints were medication appropriateness and self-reported adherence.
A randomized, controlled, multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics. Seventy-seven subjects, > or =18 years old with a hemoglobin (Hb) A(1c) > or =9% at baseline and taking at least one oral diabetes medication, were randomized to receive a pharmacist intervention (n = 43) or usual care (n = 34) for 6 months followed by a 6-month usual-care observation period for both groups. Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence. HbA(1c), medication appropriateness, and self-reported adherence were assessed at baseline, 6 months, and 12 months.
The mean HbA(1c) did not differ between groups over the 12-month period (p = 0.61). A reduction in HbA(1c) was noted for both groups over time compared with baseline (p = 0.001); however, control subjects relied more heavily on provider visits. Medication appropriateness was not improved for diabetes medications (p = 0.65). Self-reported adherence was not significantly improved by the intervention.
This pharmacist intervention did not significantly improve diabetes control, but did allow for similar HbA(1c) control with fewer physician visits. Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed.
To examine the effect of a 12-month pharmaceutical care (PC) program on vascular risk in type 2 diabetes.
We recruited 198 community-based patients randomized to PC or usual care. PC patients had face-to-face goal-directed medication and lifestyle counseling at baseline and at 6 and 12 months plus 6-weekly telephone assessments and provision of other educational material. Clinical, biochemical, and medication-related data were sent regularly to each patient's physician(s). The main outcome measure was change in HbA(1c). A diabetes-specific risk engine was used to estimate changes in 10-year coronary heart disease (CHD) and stroke risk in patients without a history of cardiovascular disease.
At total of 180 patients (91%) completed the study. Mean (95% CI) reductions were greater in PC case subjects (n = 92) than control subjects (n = 88) for HbA(1c) (-0.5% [95% CI -0.7 to -0.3] vs. 0 [-0.2 to 0.2]) and systolic (-14 mmHg [-19 to -9] vs. -7 [-11 to -2]) and diastolic (-5 mmHg [-8 to -3] vs. -2 [-4 to 1]) blood pressure (P < or = 0.043). The improvement in HbA(1c) persisted after adjustment for baseline value and demographic and treatment-specific variables. The median (interquartile range) 10-year estimated risk of a first CHD event decreased in the PC case subjects (25.1% [15.6-36.2] to 20.3 [14.6-30.2]; n = 42, P = 0.002) but not in the control subjects (26.1% [17.2-39.4] vs. 26.4 [16.7-38.0]; n = 52, P = 0.17).
A 12-month PC program in type 2 diabetes reduced glycemia and blood pressure. Pharmacist involvement contributed to improvement in HbA(1c) independently of pharmacotherapeutic changes. PC could prove a valuable component of community-based multidisciplinary diabetes care.
The Hashemite kingdom of Jordan is a small Arab country in the Middle East in the northeast of Saudi Arabia. In comparative terms, Jordan is slightly smaller than the state of Indiana. It is considered a developing country, with inadequate supplies of water and other natural resources, such as oil,
Poor metabolic control and high associated morbidity and mortality among type 2 diabetic patients require a level of care from the pharmacist that goes beyond usual dispensing. The aim of the present study was to evaluate the improvement in metabolic control, the resolution of drug-related problems (DRPs) and the increase in patient awareness of diabetes as outcomes of a pharmacotherapy follow-up program in type 2 diabetic patients.
Randomized controlled trial conducted in 14 community pharmacies in the province of Pontevedra (Spain) with 112 patients between February 2003 and March 2004. The control group received the usual care, and the intervention group patients were included in a pharmacotherapy follow-up program. This individualized program, which consists of the detection and resolution of DRPs and diabetes education, involves patients in their own care in order to obtain maximum benefit from the medication they use.
HbA(1c), Fasting Blood Glucose (FBG), lipid profile, blood pressure, body mass index (BMI), DRPs and knowledge were evaluated at the onset of the program and periodically until conclusion.
There was a significant difference in changes from baseline between the intervention and the control group in DRPs (1.7+/-1.2 versus 3.1+/-1.2 P<0.0001), knowledge (17.9+/-3.7 versus 11.4+/-6.7 points P<0.0001), HbA(1c) (7.9+/-1.7 versus 8.5+/-1.9% P<0.0001), FBG (154+/-61.3 versus 168+/-57.8 mg/dl P=0.0004), total cholesterol (202+/-41.5 versus 217+/-43.5 mg/dl P=0.0054) and SBP (135+/-16.4 versus 150+/-19.9 mmHg P=0.0006).
A substantial number of patients showed an improvement in their outcomes for the chosen metabolic indicators. Pharmacotherapy follow-up programs conducted by community pharmacists can play an important role in achieving therapeutic goals in patients with type 2 diabetes. This study shows that the incorporation of type 2 diabetic patients in a pharmacotherapy follow-up program may contribute to achieve positive clinical outcomes and will contribute to the implementation and progress of pharmacotherapy follow-up programs in community pharmacies.
The outcomes of pharmacist-managed diabetes care services in a community health center were studied.
Eligible patients were over age 18 years and had a diagnosis of type 2 diabetes mellitus. Patients were randomly assigned by the clinical pharmacist and nurse to the intervention group (n = 76) or control group (n = 73). Patients in the intervention group were enrolled in a pharmacist-managed diabetes care program. Patients in the control group received the standard diabetes care. The primary endpoint was reduction in glycosylated hemoglobin (HbA(1c)); secondary outcome measures included weight loss, an improved body mass index, decreased blood pressure, and an improved lipid panel. Quality-of-life measures (health level, satisfaction, impact, worry about disease, and worry about social and vocational issues) were also assessed.
Demographic differences between groups were not remarkable. Mean HbA(1c) levels fell significantly (p < 0.05) from baseline to nine months in both groups. A difference of 1.0 was reported between the groups' HbA(1c) levels (95% confidence interval, 0.08-1.78; p < 0.05). Satisfaction level improved from 63.7 to 77.4 in the intervention group, which was significant when compared with the control group, whose satisfaction score improved from 57.0 to 63.4 (p < 0.05).
Patients with type 2 diabetes mellitus who received pharmacist-managed diabetes care demonstrated improved HbA(1c), systolic blood pressure, and low-density-lipoprotein cholesterol levels and quality-of-life measures and met treatment goals more often than patients receiving standard care.
SPECIFIC AIM: Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.
Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1 of 2 VA Medical Centers in Washington State (n = 1,286). Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.
Our response rate was 56% (n = 717). Most respondents reported appropriate advice from physicians regarding physical activity, nutrition, and glucose monitoring (73%, 92%, and 98%, respectively), but many were not ready to change self-management behaviors. Forty-five percent reported non-adherence to medications, 42% ate a high-fat diet, and only 28% obtained either moderate or vigorous physical activity. The mean self-efficacy score for diabetes self-care was low and half of the sample reported readiness to change nutrition (52%) or physical activity (51%). Individuals with higher self-efficacy scores were more likely to adhere to medications, follow a diabetic meal plan, eat a lower fat diet, have higher levels of physical activity, and monitor their blood sugars (P < .001 for all).
Although veterans with poor diabetes control receive appropriate medical advice, many were not sufficiently confident or motivated to make and maintain self-management changes. Targeted patient-centered interventions may need to emphasize increasing self-efficacy and readiness to change to further improve VA diabetes outcomes.
Chronic diseases are the leading cause of morbidity and mortality in Jordan. The Jordanian Ministry of Health, in collaboration with the Centers for Disease Control and Prevention, established a behavioral risk factor surveillance system to monitor the behavioral risk factors associated with chronic diseases.
We used a multistage sampling design to select households from which we then randomly selected and interviewed one adult aged 18 years or older. A random subsample of the adults interviewed were then invited to visit the local health clinic, where we obtained medical measurements, including blood lipids (low-density lipoprotein, high-density lipoprotein, and triglycerides) and fasting blood glucose.
Approximately 9% of the participants in the subsample who underwent medical testing reported having been diagnosed with diabetes previously, compared with 16.9% diagnosed in our laboratory testing. About 12.3% of the participants were glucose intolerant, and about 35% were obese. Obesity was significantly associated with diabetes, high blood pressure, high cholesterol, and asthma. Compared with adults of normal weight, obese adults had an adjusted odds ratio of 3.27 (95% CI, 1.58-6.76) for diabetes, 3.69 (95% CI, 2.13-6.39) for high blood pressure, 3.45 (95% CI, 1.68-7.10) for high cholesterol, and 5.12 (95% CI, 1.53-17.19) for asthma.
Obesity, poor diet, and physical inactivity create a major chronic disease burden in Jordan that is likely to increase substantially in the next few years. Our findings argue for establishment of a more preventive orientation in health care and public health systems in Jordan.
This study aimed to determine the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glycemia (IFG), identify their associated factors, determine how the prevalence of type 2 DM has changed over 10 years, and assess the awareness and state of control of diabetes in Jordan.
Data were analyzed from a cross-sectional study that included a random sample of 1121 Jordanians aged 25 years and above. A subject was deemed affected by DM if this diagnosis was known to the patient or if his or her condition complies with the American Diabetes Association definition. IFG was defined as a fasting serum glucose level of >or=6.1 mmol/l (110 mg/dl) but <7 mmol/l. HbA(1c) >7.5% was defined as "unsatisfactory" metabolic control.
The age-standardized prevalence of diabetes and IFG was 17.1% and 7.8%, respectively, with no significant differences between women and men. Of the 195 diabetic subjects, 146 (74.9%) had been previously diagnosed. More than half (54%) of those previously diagnosed were found to be with unsatisfactory glycemic control. Compared to the 1994 survey, there was a significant increase in the prevalence of diabetes by 31.5%. Increase in age, increase in body mass index, and having a family history of diabetes were associated with increased odds of diabetes and IFG. While the level of education had no effect on IFG, higher level of education was associated with a decrease in the odds of having diabetes.
The prevalence of type 2 diabetes and IFG is high in Jordan and is increasing. More than half of the patients with diabetes have unsatisfactory control. Therefore, they are likely to benefit from programs aimed at encouraging behaviors toward achieving optimum weight as well as physical activity behaviors. Physicians caring for patients with diabetes may need to adopt a more vigorous approach for diabetes control.
The main aim of this study was to investigate physicians' expectations and experiences regarding pharmaceutical care in Jordan. A questionnaire was hand delivered to a random sample of 240 physicians. The questionnaire collected physicians' current expectations, current experiences and future expectations regarding pharmaceutical care. Physicians' positive expectations were on 6 of the current expectation statements (46% of the statements). In the experience part, for only two statements more than 50% of physicians indicated a positive experience. In the future expectations parts, physicians did not only agree on most of the statements (81% of statements) but also the agreement was by more than two third of them in most of the statements. Physicians in Jordan do not disagree with the concept of pharmaceutical care. They also accept traditional pharmacy services such as educating patients about their treatment. However they have bad experience with pharmacists providing pharmaceutical care or expanding their service. They do not think that pharmacists are currently ready to practice such service. It will be interesting to examine the change in physicians' expectations and experience in the future with the increasing number of PharmD and Master of Clinical Pharmacy graduates. © 2012 DAR Publishers/University of Jordan. All Rights Reserved.
Objective
To examine the value of glycated haemoglobin (HbA1c) concentration, a marker of blood glucose concentration, as a predictor of death from cardiovascular and all causes in men.
Design
Prospective population study.
Setting
Norfolk cohort of European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).
Subjects
4662 men aged 45-79 years who had had glycated haemoglobin measured at the baseline survey in 1995-7 who were followed up to December 1999.
Main outcome measures
Mortality from all causes, cardiovascular disease, ischaemic heart disease, and other causes.
Results
Men with known diabetes had increased mortality from all causes, cardiovascular disease, and ischaemic disease (relative risks 2.2, 3.3, and 4.2, respectively, P <0.001 independent of age and other risk factors) compared with men without known diabetes. The increased risk of death among men with diabetes was largely explained by HbA1c concentration. HbA1c was continuously related to subsequent all cause, cardiovascular, and ischaemic heart disease mortality through the whole population distribution, with lowest rates in those with HbA1c concentrations below 5%. An increase of 1% in HbA1c was associated with a 28% (P<0.002) increase in risk of death independent of age, blood pressure, serum cholesterol, body mass index, and cigarette smoking habit; this effect remained (relative risk 1.46, P=0.05 adjusted for age and risk factors) after men with known diabetes, a HbA1c concentration ≥7%, or history of myocardial infarction or stroke were excluded. 18% of the population excess mortality risk associated with a HbA1c concentration ≥5% occurred in men with diabetes, but 82% occurred in men with concentrations of 5%-6.9% (the majority of the population).
Conclusions
Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution. Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA1c through behavioural means.
The objective was to evaluate the relationships between diabetes management self-efficacy and diabetes self-management behaviors and glycemic control.
A cross-sectional design was used. A convenience sample of 223 subjects with type 2 diabetes, ≥25 years old, who sought care at the National Diabetes Center in Amman, Jordan, was enrolled. A structured interview and medical records provided the data. The instruments included a sociodemographic and clinical questionnaire, a diabetes management self-efficacy scale, and a diabetes self-management behaviors scale. Glycosylated hemoglobin was used as an index for glycemic control. The analyses are presented as proportions, means (±S.D.), odds ratios, and 95% confidence intervals obtained from logistic regressions.
Diet self-efficacy and diet self-management behaviors predicted better glycemic control, whereas insulin use was a statistically significant predictor for poor glycemic control. In addition, subjects with higher self-efficacy reported better self-management behaviors in diet, exercise, blood sugar testing, and taking medication. The findings showed that more than half of the subjects did not have their diabetes under control and that only 42% had attended diabetes education programs.
The majority of subjects did not have their diabetes controlled; their self-efficacy was low, and they had suboptimal self-management behaviors. Therefore, strategies to enhance and promote self-efficacy and self-management behaviors for patients are essential components of diabetes education programs. Furthermore, behavioral counseling and skill-building interventions are critical for the patients to become confident and be able to manage their diabetes.