Objectives: Diabetes is a major chronic health issue that continues to grow rapidly on a global level. Pharmacists are highly trusted and accessible health care providers. This systematic scoping review of the scholarly peer-reviewed published literature was performed to qualitatively synthesize evidence on all potential pharmaceutical care services that could be offered by pharmacists while caring for patients with type 1 and type 2 diabetes.
Study Design: Systematic scoping review.
Methods: We conducted a systematic scoping review of the PubMed, Cochrane, ScienceDirect, and Google Scholar databases from inception to June 2020 using Medical Subject Headings and keywords relevant to diabetes and pharmaceutical care services. Quality of the articles was appraised using the appropriate critical appraisal tools. Data collected on pharmaceutical care services were synthesized qualitatively.
Results: A total of 56 articles were included in this systematic scoping review. A total of 86 pharmaceutical care services were qualitatively summarized. Services were related to screening for/prevention of diabetes (2.3%), supporting patients (7.0%), taking history (3.5%), patient education (17.4%), assessment/designing care plans (10.5%), efficiency (3.5%), collaboration (2.3%), identification/resolution of medication-related problems (26.7%), dispensing (7.0%), patient adherence (4.7%), saving costs (7.0%), monitoring/improving outcomes (5.8%), and follow-up (2.3%). Blinded randomized controlled trials and precise estimation of the effect of pharmacist interventions in caring for patients with type 1 and type 2 diabetes are needed.
Conclusions: Pharmacists are increasingly included in multi–health care professional teams. Pharmacists are providers of pharmaceutical care services that can improve pharmacotherapy, reduce costs, and improve quality of life of patients with diabetes.
Am J Manag Care. 2022;28(9):In Press
Major databases were systematically searched for articles reporting on pharmaceutical care services for patients with diabetes, and 86 pharmaceutical care services were qualitatively synthesized.
- Pharmacists are increasingly included in multi–health care professional teams in health systems around the world.
- Pharmaceutical services were shown to improve health outcomes of patients with diabetes.
- Pharmaceutical services (n = 86) that can be offered to patients with diabetes were qualitatively synthesized.
- Findings of this review might be helpful in improving pharmaceutical care services for patients with diabetes.
The incidence of diabetes has been rising worldwide over the past several decades due to obesity, lack of exercise, smoking, and unhealthy diets rich with carbohydrates and fats.1 According to the estimates of the International Diabetes Federation, about 463 million individuals were living with diabetes around the world in 2019.2
Pharmacists are increasingly included in multi–health care professional teams. The mission of the pharmacist is provision of pharmaceutical care, which can be defined as direct, responsible provision of drug-related care for the goal of achieving specific outcomes that can improve the quality of life of the patient. Results of previous studies have shown that pharmaceutical care services improved pharmacotherapy, glycemic control, lipid profile, and quality of life of patients with diabetes.3,4
As scholarly peer-reviewed articles reporting on the role of pharmacist in caring for patients with diabetes accrue, there is a need to identify, summarize, and qualitatively synthesize evidence on the potential pharmaceutical care services that pharmacists can provide to patients with type 1 and type 2 diabetes. A systematic scoping review of the peer-reviewed literature on the role of pharmacists in caring for patients with type 1 and type 2 diabetes had not yet been conducted. Therefore, we undertook this systematic scoping review to analyze the literature published on the roles of pharmacists in caring for patients with type 1 and type 2 diabetes. Another aim of this systematic scoping review was to qualitatively synthesize evidence on all potential pharmaceutical care services that could be offered by pharmacists while caring for patients with type 1 and type 2 diabetes.
This review was conducted and reported in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Adherence to the statement is shown in eAppendix Table 1 (eAppendix available at ajmc.com). The protocol of this systematic scoping review was registered in Open Science Framework (Center for Open Science) as registration doi:10.17605/OSF.IO/5X4GY.
To identify relevant articles, 4 electronic databases were searched: PubMed, Cochrane Library, ScienceDirect, and Google Scholar. The search strategy was adopted for each database using Medical Subject Headings and relevant keywords. The search strategy is shown in eAppendix Table 2. The search syntaxes were created through combining the keywords using AND OR functions. The protocol of this search was informed by previous systematic searches.5-7 The search was conducted to include articles indexed up to and including May 1, 2021. A back snowballing approach was conducted as a secondary search within the references of the articles that were identified through the database search to identify more potential studies that could be selected and included.8
Selection of the Articles
Three investigators (F.T., R. Salah, and S.R.), who were final-year Doctor of Pharmacy students, conducted the literature search through the databases. The search was supervised by the senior investigator (R. Shawahna), who was trained to conduct a literature search through the databases used in this study by a senior librarian. The search strategy was reviewed by a senior librarian before it was applied in this study. Studies identified through the databases were imported as research information systems documents that could be opened in EndNote (Clarivate Analytics) and comma-separated values files that could be opened using Microsoft Excel (Microsoft Inc).9,10 The duplicate studies were removed. Three investigators (F.T., R. Salah, and S.R.) screened the identified studies against the inclusion and exclusion criteria. Discrepancies were resolved by discussion and consensus among the 3 researchers and the supervisor. Three investigators (F.T., R. Salah, and S.R.) screened the titles and abstracts of the identified studies that would be selected for a full-text review. Again, discrepancies were resolved by discussion and consensus among the 3 investigators and the supervisor.
Inclusion and Exclusion Criteria
Studies were candidates for a full-text review if they were related to pharmaceutical care services in diabetes. Priority for inclusion was given to studies reporting on the roles and services provided by pharmacists to patients with diabetes. The search was not restricted to a specific country of origin, year of publication, or publication status. Studies were excluded when they were reported in languages other than English, did not report on the role of pharmacists, or were not relevant to diabetes. Poster presentations in conferences, letters to the editors, and editorials were excluded.
The quality of each article was appraised using the appropriate critical appraisal tool of the Critical Appraisal Skills Programme.11 The quality of each article was appraised by 3 investigators (F.T., R. Salah, and S.R.) independently. Discrepancies were resolved by discussion and consensus among the 3 investigators and the supervisor.
Data Extraction and Synthesis
Three investigators (F.T., R. Salah, and S.R.) reviewed the full text of the selected studies independently. The investigators used text highlight tools and sticky notes to identify and mark the text on pharmaceutical services, pharmacist interventions, or recommendations for patients with diabetes. Discrepancies were resolved by discussion and consensus among the 3 investigators and the supervisor.
A data extraction form was specifically created for this study using Microsoft Excel. The data extraction form is shown in eAppendix Table 3. The 3 investigators (F.T., R. Salah, and S.R.) identified the relevant information needed for data collection independently. To ensure reproducibility, the process was repeated. Discrepancies were resolved by discussion and consensus. The text was analyzed and items relevant to pharmaceutical services, pharmacist interventions, or recommendations for patients with diabetes were collected. Because of the heterogeneous nature of the data, the results were presented as qualitative synthesis.9,10
After removing the duplicates, a total of 257 articles were identified. Upon initial screening, 107 articles were excluded. After screening against the inclusion and exclusion criteria, 94 articles were excluded. The excluded documents were editorials, letters to the editor, conference presentations, non-English articles, and those lacking pharmaceutical care services in diabetes. A total of 56 articles were included in the scoping analysis. Of those, 41 (73.2%) were research articles and 15 (26.8%) were review articles. Further, of the 56 articles included, 10 (17.9%) reported interventions by clinical pharmacists, 23 (41.1%) reported interventions by community pharmacists, 6 (10.7%) reported collaborative services, 12 (21.4%) reported on adherence, and 5 (8.9%) reported on counseling. A summary of the included studies is provided in eAppendix Table 4. The selection process is shown in the Figure. Detailed characteristics of the selected articles are shown in the eAppendix.
Articles reporting original studies, systematic reviews, and cohorts were assessed for quality using the appropriate tools. All articles included had acceptable quality in most of the domains. The majority of the studies lacked blinding and precise estimates of the effect of the intervention. Some of the systematic reviews lacked reporting of precise results and some cohort studies lacked reporting of confounding factors and precise results. Case-control studies lacked reporting of precise effects of the treatment. Results of the quality appraisal are shown in eAppendix Table 5.
Roles of Pharmacists in Caring for Patients With Diabetes
A total of 86 pharmaceutical care services were qualitatively summarized. Services were related to screening for/prevention of diabetes (2.3%), supporting patients (7.0%), taking history (3.5%), patient education (17.4%), assessment/designing care plans (10.5%), efficiency (3.5%), collaboration (2.3%), identification/resolution of medication-related problems (26.7%), dispensing (7.0%), patient adherence (4.7%), saving costs (7.0%), monitoring/improving outcomes (5.8%), and follow-up (2.3%). Details are provided in the Table.
This systematic scoping review sought to identify and summarize scholarly peer-reviewed articles reporting on pharmaceutical care of patients with type 1 and type 2 diabetes. To the best of our knowledge, this is the first systematic scoping review of the scholarly peer-reviewed literature on pharmaceutical care of patients with type 1 and type 2 diabetes. The study findings will prove informative to decision makers in health care organizations who need to make appropriate decisions about integrating pharmacists into multi–health care provider teams who care for patients with type 1 and type 2 diabetes, or who are expanding pharmaceutical services.
The studies included in this systematic scoping review focused on care services provided by pharmacists to patients with type 1 and type 2 diabetes.12-15
Screening for and Prevention of Diabetes
Today, pharmacists can play a vital role in screening for risk factors and identifying individuals who are at risk of developing diabetes.16 Contemporary pharmacies are well equipped with advanced tools that can be used to measure weight, height, blood glucose, hemoglobin A1c, blood pressure, and lipid profile including total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides.17 Pharmacists can also play a vital role in educating individuals on how to mitigate their risk factors and reduce their risk of developing diabetes in the future. Once indicators that warrant attention are identified, pharmacists can refer the patients to seek formal screening and diagnostic services in specialty care.18 These practices can promote early diagnosis, improve management, and delay onset of complications associated with diabetes.19
Supporting Patients Through Effective Relationships
Pharmacists are highly accessible and trusted health care providers.3 During their education/training, pharmacists learn how to warmly greet their patients, make them feel comfortable, pay attention to their health care needs, listen, and answer their questions.20 Patients often have fears and negative perceptions about their diabetes. Pharmacists can address these negative perceptions by reassuring patients and providing them with emotional support. These services have been shown to improve patients’ quality of life.21
Pharmacists can take complete and reliable medication histories from their patients. These histories are vital in informing lifestyle and pharmacotherapeutic interventions.19 Pharmacists are also competent in conducting medication reconciliations. Access to complete patient information has been shown to facilitate the design of suitable care plans, making recommendations, and/or amending care plans.22
Education about diabetes. Pharmacists can play an important role in educating patients about their diabetes, what complications are associated with unmanaged diabetes, how to live and cope with diabetes, how to monitor blood glucose levels, and how to prevent/delay the incidence of complications.23,24 It has been argued that well-informed patients are more likely to achieve glycemic control.19,25,26
Education about antidiabetic medications. Pharmacists are experts in medications and can educate patients on how to get the most benefit out of their medications.23 Pharmacists have designed appropriate interventions to increase patients’ general attentiveness to their medications: when to use them, how to use them, how to store them, what adverse effects could be associated with them, and what medications, herbs, and foods to avoid while taking them.27,28
Education about lifestyle modifications. Pharmacists can educate patients on how to lead a diabetes-compatible lifestyle, including, for instance, a healthy diet, regular exercise, weight control, and smoking cessation.19 Some patients can adequately control their blood glucose with lifestyle modifications and decrease their dependence on antidiabetic medications.29
Education about self-management. Pharmacists can also educate patients how to self-manage their diabetes. Patients can learn how to adequately use home monitoring devices, such as glucometers and digital blood pressure monitors, and how to keep track of and document their home readings.16 Patients can learn what ranges are considered normal or target and when to seek medical advice.27 Pharmacists can also teach their patients, especially those with type 1 diabetes, how to recognize, avoid, and/or manage states of hypoglycemia.
Assessment of Patients and Designing Care Plans
Pharmacists help assess patients with diabetes based on their history and laboratory tests to initiate, adjust/modify/optimize, and/or discontinue mediation therapy.30 In modern health care delivery, patients’ cases are presented in multidisciplinary health care team discussions in which pharmacists actively participate. Often, the best care plan decisions are those made jointly.19
Individualized Care Plans
Individualized pharmaceutical services should be designed and provided to patients after a complete discussion of their medical, family, and social history; laboratory findings; glycemic control; comorbid conditions; and macrovascular and microvascular complications.24 Individualized care plans have been advocated as a useful approach to effectively address patients’ specific health care needs.19,31
Efficiency in Providing Services
In modern health care systems, pharmacists have several roles and responsibilities that, when performed efficiently, have been shown to improve the quality of care provided to patients; this has translated into improved glycemic control and delaying short-term and long-term complications of diabetes.32,33
Collaboration With Other Health Care Providers
Study results have shown that including pharmacists in the care team often results in improved medication management, optimization of medication regimens, reduction of medication-related problems, and easier achievement of therapeutic goals.30,34,35 Additionally, inclusion of pharmacists was shown to complement the expertise of other health care providers and enable provision of comprehensive management and referral services to patients with diabetes.36
Identification and Resolution of Medication-Related Problems
Patients may experience medication-related problems, which pharmacists, as experts in medications, can help identify and resolve.19 These problems can include inappropriate doses; the method, timing, frequency, or duration of administration; dosage form; misspelled medication orders; adverse drug reactions; allergies; drug-drug, food-drug, and drug-disease interactions; and cost of therapy.37,38 Resolving these problems can reduce patient mortality and morbidity, save costs, and improve efficiency of the health care system.
Dispensing medications is one of the classical roles of pharmacists in all health care systems.39 Before dispensing, pharmacists review the medication orders for their validity. Pharmacists should dispense the correct drug product, dose, amount, and package.40
Improving Patient Adherence to Medications
Pharmacists can help assess patients’ adherence to their antidiabetic medications at the right dosage, frequency, and timing.41 Pharmacists can address promoters of nonadherence and improve adherence by forming a good rapport with patients and providing comprehensive education/counseling on patients’ antidiabetic medications. They can frankly discuss the consequences of nonadherence, thus improving patients’ commitment to taking their medication.42,43 Adherence to taking medications has been shown to improve glycemic control.
Study results have shown that patients are less likely to adhere to their medications when the costs of the medications are high.44,45 Pharmacists can refer patients to sources that provide free medications to those who are unable to afford them.3 Whenever possible, pharmacists should attempt to modify the care plan and substitute some medications with more affordable alternatives after consultation with the prescribers.
Monitoring and Improvement of Patient Outcomes
Pharmacists can review patient health records, assess patients’ adherence to their medications, and monitor their health-related outcomes.31 Such pharmaceutical services have been shown to help patients achieve therapeutic goals, reduce incidence of complications that are associated with nonadherence, and improve their satisfaction, quality of life, and how well they cope with their disease.3 Improving glycemic control and patient outcomes has been shown to reduce emergency and hospital admissions, health care–associated costs, morbidity, and mortality among patients with diabetes.19,46
A pharmacist can schedule visits or telephone calls to follow up with patients and educate/counsel them regarding their medications, screen for medication-related problems, and ensure adherence to medications, diet, and lifestyle.47 The pharmacist can also remind patients to attend their scheduled laboratory tests and visits to their health care providers for foot, eye, kidney, cardiovascular, and neurologic checks.30,47,48
Strengths and Limitations of the Study
Results of this systematic scoping review can be interpreted after considering a number of strengths and limitations. First, this is the first systematic scoping review with qualitative synthesis on the pharmaceutical care services provided to patients with type 1 and type 2 diabetes. Systematic scoping reviews with qualitative synthesis are particularly important in summarizing and synthesizing evidence—in this case, on the role of pharmacists in caring for patients with type 1 and type 2 diabetes. Second, the databases PubMed, Cochrane, ScienceDirect, and Google Scholar were extensively searched in this study. These databases index authentic scholarly journals in the field. Third, because the search strategy was not restricted to a certain study design such as randomized controlled trials, a wide coverage of the subject under investigation was possible. Fourth, the articles included in this study were of acceptable quality as shown by the quality appraisal. Quality appraisal is not often conducted in scoping reviews. However, because this study was a systematic scoping review with qualitative synthesis, quality appraisal was conducted. Finally, 3 researchers conducted all steps of the study and a fourth senior researcher oversaw all the stages of the study. This should have added rigor to the methodology used in this study.
On the other hand, this study is not without limitations. First, the articles included in this review were in English only. Although this presumably reduced the bias brought about by incorrect translation, it also could have resulted in exclusion of some important findings published in languages other than English. Second, results of this study were synthesized qualitatively. Meta-analysis is often conducted to pool evidence from quantitative studies. In this study, a systematic scoping review approach was followed to summarize, discuss, and qualitatively synthesize the roles of pharmacists in caring for patients with type 1 and type 2 diabetes.49 Third, clinical trial registries were not systematically searched to identify registered studies with reported results that could be used in this review. It is worth mentioning that the aim of this study was to review only scholarly, peer-reviewed, published articles. Finally, we did not search subscription-based databases such as Scopus and Web of Science; doing so would have resulted in a larger number of articles. However, the databases searched in this study index a large number of scholarly sources on pharmaceutical care of patients with type 1 and type 2 diabetes.
Pharmacists are increasingly included in multi–health care professional teams. Pharmaceutical care services and pharmacist interventions were shown to improve glycemic control, patient satisfaction, and quality of life. Additionally, pharmaceutical care services and pharmacist interventions were shown to reduce complications of diabetes, health care–associated costs, morbidity, and mortality among patients with diabetes.
The authors would like to thank An-Najah National University for making this study possible.
Author Affiliations: Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University (RSh), Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University (RSh), Nablus, Palestine; Doctor of Pharmacy Program, Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University (FT, RSa, SR), Nablus, Palestine.
Source of Funding: None.
Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (RSh); acquisition of data (RSh, FT, RSa, SR); analysis and interpretation of data (RSh, FT, RSa, SR); drafting of the manuscript (RSh, FT, RSa, SR); critical revision of the manuscript for important intellectual content (RSh, FT, RSa, SR); statistical analysis (RSh, FT, RSa, SR); provision of patients or study materials (RSh, FT, RSa, SR); administrative, technical, or logistic support (RSh, FT, RSa, SR); and supervision (RSh).
Address Correspondence to: Ramzi Shawahna, PhD, Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences, New Campus, An-Najah National University, PO Box 7, Building 19, Office 1340, Nablus, Palestine. Email: [email protected].
1. Luo J, Hendryx M, Laddu D, et al. Racial and ethnic differences in anthropometric measures as risk factors for diabetes. Diabetes Care. 2019;42(1):126-133. doi:10.2337/dc18-1413
2. Saeedi P, Petersohn I, Salpea P, et al; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843
3. Pousinho S, Morgado M, Falcão A, Alves G. Pharmacist interventions in the management of type 2 diabetes mellitus: a systematic review of randomized controlled trials. J Manag Care Spec Pharm. 2016;22(5):493-515. doi:10.18553/jmcp.2016.22.5.493
4. Nogueira M, Otuyama LJ, Rocha PA, Pinto VB. Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Einstein (Sao Paulo). 2020;18:eRW4686. doi:10.31744/einstein_journal/2020RW4686
5. Amoudi M, Nairat Q, Shawahna R. Knowledge, attitudes, and practices of physiotherapists with regard to epilepsy and patients with epilepsy: a systematic scoping review. Epilepsy Behav. 2021;124:108367. doi:10.1016/j.yebeh.2021.108367
6. Shawahna R, Ghoul A, Zaid N, Damrah W, Jaber M. Improving communication with patients discharged from the emergency department with noncardiac chest pain: a scoping review with narrative synthesis. Emerg Med Int. 2021;2021:6695210. doi:10.1155/2021/6695210
7. Shawahna R. Quality indicators of pharmaceutical care for integrative healthcare: a scoping review of indicators developed using the Delphi technique. Evid Based Complement Alternat Med. 2020;2020:9131850. doi:10.1155/2020/9131850
8. Greenhalgh T, Peacock R. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. BMJ. 2005;331(7524):1064-1065. doi:10.1136/bmj.38636.593461.68
9. Shawahna R, Batta A, Asa’ad M, Jomaah M, Abdelhaq I. Exercise as a complementary medicine intervention in type 2 diabetes mellitus: a systematic review with narrative and qualitative synthesis of evidence. Diabetes Metab Syndr. 2021;15(1):273-286. doi:10.1016/j.dsx.2021.01.008
10. Shawahna R, Khalaily S, Abu Saleh D. Promoters of therapeutic inertia in managing hypertension: a consensus-based study. Am J Manag Care. 2021;27(11):480-486. doi:10.37765/ajmc.2021.88775
11. CASP checklists. Critical Appraisal Skills Programme. Accessed January 18, 2021. https://casp-uk.net/casp-tools-checklists/
12. Turnacilar M, Sancar M, Apikoglu-Rabus S, Hursitoglu M, Izzettin FV. Improvement of diabetes indices of care by a short pharmaceutical care program. Pharm World Science. 2009;31(6):689-695. doi:10.1007/s11096-009-9333-9
13. Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC. Influence of pharmaceutical care on health outcomes in patients with type 2 diabetes mellitus. Br J Clin Pharmacol. 2009;67(5):547-557. doi:10.1111/j.1365-2125.2009.03391.x
14. Chen JH, Ou HT, Lin TC, Lai EC, Kao YH. Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus: a randomized controlled trial. Int J Clin Pharm. 2016;38(1):88-95. doi:10.1007/s11096-015-0210-4
15. Ko JJ, Lu J, Rascati K, et al. Analysis of glycemic control of a pharmacist-led medication management program in patients with type 2 diabetes. J Manag Care Spec Pharm. 2016;22(1):32-37. doi:10.18553/jmcp.2016.22.1.32
16. Campbell RK. Role of the pharmacist in diabetes management. Am J Health Syst Pharm. 2002;59(suppl 9):S18-S21. doi:10.1093/ajhp/59.suppl_9.S18
17. Alzubaidi HT, Chandir S, Hasan S, McNamara K, Cox R, Krass I. Diabetes and cardiovascular disease risk screening model in community pharmacies in a developing primary healthcare system: a feasibility study. BMJ Open. 2019;9(11):e031246. doi:10.1136/bmjopen-2019-031246
18. Meece J. Improving medication adherence among patients with type 2 diabetes. J Pharm Pract. 2014;27(2):187-194. doi:10.1177/0897190013513803
19. Javaid Z, Imtiaz U, Khalid I, et al. A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan. BMC Health Serv Res. 2019;19(1):409. doi:10.1186/s12913-019-4274-z
20. Worley MM, Schommer JC, Brown LM, et al. Pharmacists’ and patients’ roles in the pharmacist-patient relationship: are pharmacists and patients reading from the same relationship script? Res Social Adm Pharm. 2007;3(1):47-69. doi:10.1016/j.sapharm.2006.03.003
21. Urata K, Hashimoto K, Horiuchi R, Fukui K, Arai K. Impact of diabetes perceptions on medication adherence in Japan. Pharmacy (Basel). 2019;7(4):144. doi:10.3390/pharmacy7040144
22. Taveira TH, Friedmann PD, Cohen LB, et al. Pharmacist-led group medical appointment model in type 2 diabetes. Diabetes Educ. 2010;36(1):109-117. doi:10.1177/0145721709352383
23. Bukhsh A, Khan TM, Lee SWH, Lee LH, Chan KG, Goh BH. Efficacy of pharmacist based diabetes educational interventions on clinical outcomes of adults with type 2 diabetes mellitus: a network meta-analysis. Front Pharmacol. 2018;9:339. doi:10.3389/fphar.2018.00339
24. Aquino JA, Baldoni AO, Di Lorenzo Oliveira C, Cardoso CS, de Figueiredo RC, Sanches C. Pharmacotherapeutic empowerment and its effectiveness in glycemic control in patients with diabetes mellitus. Diabetes Metab Syndr. 2019;13(1):137-142. doi:10.1016/j.dsx.2018.08.002
25. Venkatesan R, Devi ASM, Parasuraman S, Sriram S. Role of community pharmacists in improving knowledge and glycemic control of type 2 diabetes. Perspect Clin Res. 2012;3(1):26-31. doi:10.4103/2229-3485.92304
26. Mouhtadi BB, Alame MM, Malaeb B, Hallit S, Salameh P, Malaeb D. Physician-community pharmacist collaborative care in diabetes management: a pilot study. J Drug Assess. 2018;7(1):61-65. doi:10.1080/21556660.2018.1535437
27. Cani CG, da Silva Girão Lopes L, Queiroz M, Nery M. Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital. Clinics (Sao Paulo). 2015;70(2):102-106. doi:10.6061/clinics/2015(02)06
28. Nabulsi NA, Yan CH, Tilton JJ, Gerber BS, Sharp LK. Clinical pharmacists in diabetes management: what do minority patients with uncontrolled diabetes have to say? J Am Pharm Assoc (2003). 2020;60(5):708-715. doi:10.1016/j.japh.2020.01.024
29. Rotta I, Salgado TM, Silva ML, Correr CJ, Fernandez-Llimos F. Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000-2010). Int J Clin Pharm. 2015;37(5):687-697. doi:10.1007/s11096-015-0137-9
30. Chong MT. Pharmacist interventions in improving clinical outcomes in patients with type 2 diabetes mellitus among the underrepresented population: a collaborative ambulatory care pharmacy practice (CAPP) approach. J Res Pharm Pract. 2020;9(1):3-9. doi:10.4103/jrpp.JRPP_19_75
31. Bindu Murali A, Boban B, Karoor Shanmughan A, Marimuthu K, Ramakrishnan Sreelatha A, Xavier A. Medication therapy management (MTM): an innovative approach to improve medication adherence in diabetics. Drug Metab Pers Ther. 2016;31(3):151-155. doi:10.1515/dmpt-2016-0016
32. Naybour M, Remenyte-Prescott R, Boyd M. Reliability and efficiency evaluation of a community pharmacy dispensing process using a coloured Petri-net approach. Reliab Eng Syst Saf. 2019;182:258-268. doi:10.1016/j.ress.2018.09.022
33. Vivian EM. The pharmacist’s role in maintaining adherence to insulin therapy in type 2 diabetes mellitus. Consult Pharm. 2007;22(4):320-332. doi:10.4140/tcp.n.2007.320
34. Gardea J, Papadatos J, Cadle R. Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large Veterans Affairs medical center. Pharm Pract (Granada). 2018;16(2):1164. doi:10.18549/PharmPract.2018.02.1164
35. Aguiar PM, da Silva CHP, Chiann C, Dórea EL, Lyra DP Jr, Storpirtis S. Pharmacist-physician collaborative care model for patients with uncontrolled type 2 diabetes in Brazil: results from a randomized controlled trial. J Eval Clin Pract. 2018;24(1):22-30. doi:10.1111/jep.12606
36. Brooks AD, Rihani RS, Derus CL. Pharmacist membership in a medical group’s diabetes health management program. Am J Health Syst Pharm. 2007;64(6):617-621. doi:10.2146/ajhp060095
37. Nasution A, Dalimunthe A, Khairunnisa K. Pharmacists intervention reduced drug-related problems in the treatment of patients with type 2 diabetes mellitus. Open Access Maced J Med Sci. 2019;7(22):3856-3860. doi:10.3889/oamjms.2019.519
38. Johnson M, Jastrzab R, Tate J, et al. Evaluation of an academic-community partnership to implement MTM services in rural communities to improve pharmaceutical care for patients with diabetes and/or hypertension. J Manag Care Spec Pharm. 2018;24(2):132-141. doi:10.18553/jmcp.2018.24.2.132
39. Payne K, Unni EJ, Jolley B. Impact of dispensing services in an independent community pharmacy. Pharmacy (Basel). 2019;7(2):44. doi:10.3390/pharmacy7020044
40. Shawahna R, Masri D, Al-Gharabeh R, Deek R, Al-Thayba L, Halaweh M. Medication administration errors from a nursing viewpoint: a formal consensus of definition and scenarios using a Delphi technique. J Clin Nurs. 2016;25(3-4):412-423. doi:10.1111/jocn.13062
41. Brown MT, Bussell J, Dutta S, Davis K, Strong S, Mathew S. Medication adherence: truth and consequences. Am J Med Sci. 2016;351(4):387-399. doi:10.1016/j.amjms.2016.01.010
42. Kharjul M, Braund R, Green J. The influence of pharmacist-led adherence support on glycaemic control in people with type 2 diabetes. Int J Clin Pharm. 2018;40(2):354-359. doi:10.1007/s11096-018-0606-z
43. Labrador Barba E, Rodríguez de Miguel M, Hernández-Mijares A, et al. Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system. Patient Prefer Adherence. 2017;11:707-718. doi:10.2147/PPA.S122556
44. Erku DA, Ayele AA, Mekuria AB, Belachew SA, Hailemeskel B, Tegegn HG. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study. Pharm Pract (Granada). 2017;15(3):1026. doi:10.18549/PharmPract.2017.03.1026
45. Jamshed SQ, Siddiqui MJ, Rana B, Bhagavathula AS. Evaluation of the involvement of pharmacists in diabetes self-care: a review from the economic perspective. Front Public Health. 2018;6:244. doi:10.3389/fpubh.2018.00244
46. Biltaji E, Yoo M, Jennings BT, Leiser JP, McAdam-Marx C. Outcomes associated with pharmacist-led diabetes collaborative drug therapy management in a Medicaid population. J Pharm Health Serv Res. 2017;8(1):59-62. doi:10.1111/jphs.12162
47. Johnson JM, Carragher R. Interprofessional collaboration and the care and management of type 2 diabetic patients in the Middle East: a systematic review. J Interprof Care. 2018;32(5):621-628. doi:10.1080/13561820.2018.1471052
48. Cioffi ST, Caron MF, Kalus JS, Hill P, Buckley TE. Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic. Ann Pharmacother. 2004;38(5):771-775. doi:10.1345/aph.1D359
49. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. doi:10.1186/s12874-018-0611-x