Review article
Effect of pharmacist intervention on glycemic control in diabetes

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Abstract

Aim

To conduct a meta-analysis evaluating the effect of pharmacist intervention on glycemic control.

Methods

A systematic search of Medline and CENTRAL was conducted from the earliest possible date through June 2010. Trials were included if they were randomized controlled trials in a diabetic population, evaluated any form of pharmacist intervention and reported data on hemoglobin A1C (A1C). A random-effects model was used to calculate weighted mean differences (WMDs) and 95% confidence intervals.

Results

Fourteen trials (n = 2073) evaluating the effect of pharmacist intervention on glycemic control were identified. Pharmacist intervention significantly lowered A1C (n = 14 trials, WMD −0.76%, 95%CI −1.06 to −0.47) and fasting blood glucose (FBG) (n = 4 trials, WMD −29.32 mg/dL, 95%CI −39.54 to −19.10). A moderate to high degree of statistical heterogeneity was observed in these analyses (I2 ≥ 44.1% for both).

Conclusions

Our findings demonstrate statistically and clinically significant associations between pharmacist intervention and improvement in glycemic control.

Introduction

Diabetes is a chronic condition that requires long term medical care. The incidence of type 2 diabetes is growing rapidly due to increased obesity and sedentary lifestyles [1]. Several randomized clinical trials (RCTs) have assessed the impact of pharmacist intervention on glycemic control in patients with diabetes; however, they have provided inconsistent results [2]. Thus, the goal of this meta-analysis was to systematically assess the impact of pharmacist intervention on glycemic control in patients with diabetes.

Section snippets

Materials and methods

To be included in this meta-analysis, trials had to be a RCT evaluating the effect of pharmacist intervention in patients with diabetes and report endpoint data on hemoglobin A1C (A1C). We conducted a systematic literature review of MEDLINE and Cochrane CENTRAL from the earliest possible date through June 2010. The search strategy utilized the MeSH terms and keywords ‘diabetes mellitus’, ‘diabetes mellitus, type 2’, ‘type 2 diabetes’, ‘noninsulin dependent diabetes’, ‘NIDDM, ‘T2DM’, ‘type 1

Results

The initial literature review yielded 309 potential literature citations (Fig. 1). Two independent reviewers assessed 37 full-text articles for eligibility. Articles were excluded because they were not RCTs (n = 2), enrolled patients without diabetes (n = 2), did not evaluate pharmacist intervention (n = 4), did not report A1C as an endpoint (n = 9), or included the pharmacist working as part of an interdisciplinary team (n = 6). Thus, a total of 14 RCTs (n = 2073, duration of pharmacist

Discussion

In this meta-analysis of 14 RCTs, patients with type 1 or type 2 diabetes receiving pharmacist intervention demonstrated statistically significant improvements in both A1C and FBG levels as compared to subjects receiving usual care. Since many U.S. Food and Drug Administration approved anti-diabetic medications, including glucagon-like peptide-1 (GLP-1) agonists, alpha-glucosidase inhibitors and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), lower A1C levels by 0.5–1.0% [18], the 0.76%

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgement

All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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