Glycemic control through pharmaceutical care: a meta-analysis of randomized controlled trials

Objectives: To evaluate the effect of pharmaceutical care (PC) on glycemic control in patients with type 2 diabetes mellitus. Methods: A systematic search of literature was conducted to identify randomized controlled trials (RCTs) in patients with type 2 diabetes mellitus. RCTs published in English between January 2011 and November 2015 were identified using nine electronic databases: MEDLINE, International Pharmaceutical Abstracts (IPA), EMBASE, Scopus, Science Direct, Cochrane Library, Web of Science, Springer Link, and Google Scholar. Studies were included if they outlined a pharmaceutical care intervention conducted by pharmacists alone or in collaboration with other health care professional(s). The studies were identified and data was extracted independently by two reviewers. The meta-analysis was conducted by using RevMan version 5.3. A random-effects model was used to calculate the standard mean difference (SMD) with a 95% confidence interval in glycosylated haemoglobin (HbA1_C) levels. Key findings: Thirteen RCTs outlining PC interventions in type 2 diabetes mellitus patients (n = 1828) were included. The interventions included care plan development, medication reviews, patient education and counselling of patients with follow-up. All RCTs reported statistically significant reductions in HbA1c in the intervention group (SMD = −0.97; 95% CI −1.21 to −0.73; P = 0.00001) as compared to the control group. Significant heterogeneity in SMD (χ² = 68.96) was observed. Conclusions: The findings suggest that PC interventions are effective (at least in short-term follow-up in hospital setting) in reducing HbA1c levels in patients with type 2 diabetes mellitus. Pharmacists, working alone or in collaboration with other health professionals have significant impact on improving the health status of patients with type 2 diabetes mellitus.