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      Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

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          Abstract

          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/m 2 to -1.94 kg/m 2; 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.

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          Most cited references80

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            Adherence to Medication

            New England Journal of Medicine, 353(5), 487-497
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              Prediction of Coronary Heart Disease Using Risk Factor Categories

              The objective of this study was to examine the association of Joint National Committee (JNC-V) blood pressure and National Cholesterol Education Program (NCEP) cholesterol categories with coronary heart disease (CHD) risk, to incorporate them into coronary prediction algorithms, and to compare the discrimination properties of this approach with other noncategorical prediction functions. This work was designed as a prospective, single-center study in the setting of a community-based cohort. The patients were 2489 men and 2856 women 30 to 74 years old at baseline with 12 years of follow-up. During the 12 years of follow-up, a total of 383 men and 227 women developed CHD, which was significantly associated with categories of blood pressure, total cholesterol, LDL cholesterol, and HDL cholesterol (all P or =130/85). The corresponding multivariable-adjusted attributable risk percent associated with elevated total cholesterol (> or =200 mg/dL) was 27% in men and 34% in women. Recommended guidelines of blood pressure, total cholesterol, and LDL cholesterol effectively predict CHD risk in a middle-aged white population sample. A simple coronary disease prediction algorithm was developed using categorical variables, which allows physicians to predict multivariate CHD risk in patients without overt CHD.
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                Author and article information

                Contributors
                Journal
                Pharm Pract (Granada)
                Pharm Pract (Granada)
                Pharmacy Practice
                Centro de Investigaciones y Publicaciones Farmaceuticas
                1885-642X
                1886-3655
                Jul-Sep 2020
                28 August 2020
                : 18
                : 3
                : 2000
                Affiliations
                MSC. CICS-UBI – Health Sciences Research Centre, University of Beira Interior . Covilhã (Portugal). sarahpousinho@ 123456gmail.com
                PhD, PharmD. CICS-UBI – Health Sciences Research Centre, University of Beira Interior . Covilhã (Portugal). mmorgado@ 123456fcsaude.ubi.pt
                PhD. Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG) . Guarda (Portugal). anaplacido@ 123456ipg.pt
                PhD, PharmD. CICS-UBI – Health Sciences Research Centre, University of Beira Interior . Covilhã (Portugal). froque@ 123456ipg.pt
                PhD, PharmD. Centre for Neuroscience and Cell Biology, Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra . Coimbra (Portugal). acfalcao@ 123456ff.uc.pt
                PhD, PharmD. CICS-UBI – Health Sciences Research Centre, University of Beira Interior . Covilhã (Portugal). gilberto@ 123456fcsaude.ubi.pt
                Author information
                https://orcid.org/0000-0003-2710-2990
                https://orcid.org/0000-0003-2112-2835
                https://orcid.org/0000-0002-2316-6770
                https://orcid.org/0000-0003-0169-3788
                https://orcid.org/0000-0002-3854-6549
                https://orcid.org/0000-0002-4213-0714
                Article
                pharmpract-18-2000
                10.18549/PharmPract.2020.3.2000
                7470242
                6792d636-8c0b-48d6-b53f-944975d148fd
                Copyright: © Pharmacy Practice and the Authors

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 May 2020
                : 16 August 2020
                Funding
                Funded by: FCT- Fundação para a Ciência e Tecnologia
                Award ID: SAICT-POL/23585/2016
                Categories
                Original Research

                diabetes mellitus,type 2,pharmacists,pharmacies,pharmaceutical services,blood glucose,glycated hemoglobin a,quality of life,medication adherence,cost-benefit analysis,systematic reviews as topic

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