Effectiveness of pharmacist-led educational interventions on self-care activities and glycemic control of type 2 diabetes patients: a systematic review and meta-analysis

Allah Bukhsh1 School of Pharmacy, Monash University Malaysia, Selangor 47500, Malaysia, [email protected];2 Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan, [email protected]Correspondence[email protected]

Xuan Ying Tan1 School of Pharmacy, Monash University Malaysia, Selangor 47500, Malaysia, [email protected]

Kok Gan Chan3 International Genome Centre, Jiangsu University, Zhenjiang, China, [email protected];4 Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia, [email protected]Correspondence[email protected]

Learn-Han Lee1 School of Pharmacy, Monash University Malaysia, Selangor 47500, Malaysia, [email protected];2 Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan, [email protected];5 Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia;6 Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia;7 Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia;8 Center of Health Outcomes Research and Therapeutic, Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand

Bey-Hing Goh1 School of Pharmacy, Monash University Malaysia, Selangor 47500, Malaysia, [email protected];2 Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan, [email protected];5 Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia;6 Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia;7 Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia;8 Center of Health Outcomes Research and Therapeutic, Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand

Tahir Mehmood Khan1 School of Pharmacy, Monash University Malaysia, Selangor 47500, Malaysia, [email protected];2 Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan, [email protected]

Abstract

Background

Effectiveness of pharmacist-led educational interventions on self-care activities and glycemic control of type 2 diabetes mellitus (T2DM) patients is vague. The purpose of this review is to appraise the effect of pharmacist-led educational interventions on self-care activities and levels of glycated hemoglobin of T2DM patients.

Methods

Five electronic databases were searched from date of database inception to September 2017. Randomized clinical trials examining the effectiveness of pharmacist-led educational interventions, directed at T2DM patients only, were included for systematic review and meta-analysis. The protocol is available with PROSPERO (CRD42017078854).

Results

Eleven studies, involving n=1,544 T2DM patients, were included in this systematic review. Meta-analysis demonstrated that pharmacist-led interventions had a significant effect on lowering of the levels of glycated hemoglobin (−0.66; 95% CI [−0.83, −0.50]; I²=58.3%; P=0.008), in comparison to usual care. Self-care activities were assessed by using Summary of Diabetes Self-care Activities tool in eight studies. Overall meta-analysis of self-care activities for included studies demonstrated a significant effect of pharmacist-led interventions on improvement of self-monitoring of blood glucose (1.62; 95% CI [0.92, 2.32]; I²=70.5%; P=0.005), foot care (1.20; 95% CI [0.49, 1.90]; I²=95.0%; P<0.001), and overall diet (1.16; 95% CI [0.38, 1.93]; I²=64.2%; P=0.094).

Conclusion

The findings of this review demonstrate a significantly positive effect of pharmacist-led educational interventions on HbA1c levels and self-care practices among T2DM patients.

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Supplementary materials

Figure S1 Risk of bias summary of included studies (n=11).

Figure S2 Risk bias graph of included studies (n=11).

Figure S3 Sub-group meta-analysis for HbA1c on the basis of region (n=11). Weights are from random effects analysis.

Figure S4 Sub-group meta-analysis for HbA1c of included RCTs on the basis of intervention provider (n=11).

Note: Weight are from random effects analysis.

Figure S5 Sub-group meta-analysis for HbA1c of included RCTs on the basis of duration of study (n=11).

Note: Weights are from random effects analysis.

Figure S6 Sub-group meta-analysis for HbA1c of included RCTs on the basis of baseline HbA1c (n=11).

Note: Weights are from random-effects analysis.

Figure S7 Funnel Plot of Publication Bias.

Disclosure

AB received a PhD Merit Scholarship from Monash University. KGC received a grant from the University of Malaya (PG089-2015B). The authors report no other conflicts of interest in this work.