Effect of Pharmaceutical Care Programs on Glycemic Control in Patients with Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background:

Diabetes mellitus is a common disease that has an increasing influence on the health of human beings. While the role of pharmaceutical care (PC) programs in the treatment of patients with diabetes mellitus is well established, there is little research that quantitatively and comprehensively assesses the impact of PC programs on glycemic control in diabetics.

Objective:

To evaluate the effect of PC programs on glycemic control in patients with diabetes mellitus.

Methods:

Publications on PC programs and randomized controlled trials (RCTs) of glycemic control were retrieved by searching MEDLINE, Embase, Cochrane, Elsevier, Chinese Biomedicine Database, and Chinese Journal Full-Text Database databases from January 1996 through February 2010. Data were extracted by 2 reviewers independently, based on their correlation with this project, and then evaluated with meta-analysis. The meta-analysis was conducted using STATA version 10.1. Begg-Mazumdar's funnel plot was generated to determine the potential impact of publication bias.

Results:

Fourteen RCTs, with a total of 1770 patients with diabetes mellitus, were included in this meta-analysis. Pharmacists were involved in all of these PC interventions. The average ± SD study period of included trials was 9.5 ± 4.1 months. Drug counseling, drug therapy management, lifestyles education, self-monitoring, and recommendations of drug therapy changes were the most frequently used interventions. All of the trials reported the reduction of hemoglobin A_1c (A1C) as the primary clinical outcome of PC intervention. Compared with the usual-care control groups, the PC intervention groups had significant reduction in A1C levels (weighted mean difference −0.68; 95% CI-1.03 to −0.34; p = 0.000).

Conclusions:

PC programs delivered separately or in combination by pharmacists and other health professionals can lead to an improvement in glycemic control. The incorporation of PC programs into disease management should be strongly considered.