IMPACT OF PHARMACIST LED INTERVENTIONS IN MEDICATION ADHERENCE OF DIABETIC PATIENTS BASED IN SOUTH ASIAN COUNTRIES: A NARRATIVE REVIEW
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Abstract
Background: Diabetes mellitus poses a growing global health challenge, with approximately 463 million adults (9.3%) aged 20–79 affected worldwide. Without effective intervention, this figure is projected to rise to 578 million (10.2%) by 2030. One of the major barriers to effective management of type 2 diabetes mellitus (T2DM) is poor medication adherence, which directly impacts glycemic control and increases the risk of complications.
Objective: To assess the effectiveness of pharmacist-led interventions in improving medication adherence and glycemic outcomes among patients with T2DM in South Asian countries.
Methods: This narrative review analyzed 21 studies published within the last two decades across five South Asian countries: Bangladesh (n=1), Sri Lanka (n=1), Nepal (n=3), Pakistan (n=8), and India (n=8). Studies included randomized controlled trials, interventional and longitudinal studies that evaluated pharmacist-led educational or counseling interventions. Eligible participants were adult T2DM patients receiving either oral hypoglycemic agents or insulin. Data collection methods included validated instruments such as the Diabetes Knowledge Questionnaire (DKQ), Diabetes Self-Management Questionnaire (DSMQ), and Morisky Medication Adherence Scale (MMAS), as well as laboratory parameters like HbA1c and fasting blood glucose levels. Statistical analyses in the primary studies included pre-post comparisons, multivariate models, and paired t-tests to measure intervention impact.
Results: Across the reviewed studies, pharmacist-led interventions led to significant reductions in HbA1c (mean decrease: 0.8% to 1.2%) and fasting blood glucose (average reduction: 15–30 mg/dL). Medication adherence improved by 25–60% in intervention groups compared to controls. Improvements were also seen in patient knowledge, self-care behaviors, and health-related quality of life. Interventions were effective across diverse settings, including hospitals, community pharmacies, and rural clinics.
Conclusion: Pharmacist-led interventions significantly enhance medication adherence, glycemic control, and patient education in T2DM management. Integrating pharmacists into multidisciplinary care models can optimize diabetes care and reduce the long-term burden of complications, particularly in resource-limited South Asian settings.
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References
Sukartini T, Nursalam N, Pradipta RO, Ubudiyah M. Potential methods to improve self-management in those with type 2 diabetes: a narrative review. Int J Endocrinol Metab. 2023;21(1): e119698.
Liu Y, Chen Y, Lin Y, Wang Y, Wang X. The role of health literacy in diabetes knowledge, self-care, and glycemic control: a meta-analysis. J Gen Intern Med. 2020;35(7):1952–63.
Qiao Y, Tsang CCS, Hohmeier KC, Dougherty S, Hines L, Chiyaka ET, et al. Association between medication adherence and healthcare costs among patients receiving the low-income subsidy. Value Health. 2020;23(9):1210–7.
Banu B, Khan MMH, Ali L, Barnighausen T, Sauerborn R, Souares A. Pattern and predictors of non-adherence to diabetes self-management recommendations among patients in peripheral district of Bangladesh. Trop Med Int Health. 2024.
Mamunuwa A. Impact of medication counselling by pharmacists in patients with diabetes, attending rural and urban outpatient clinics in Sri Lanka. 2020.
Upadhyay DK, Ibrahim MIM, Mishra P, Alurkar VM, Ansari M. Does pharmacist-supervised intervention through pharmaceutical care program influence direct healthcare cost burden of newly diagnosed diabetics in a tertiary care teaching hospital in Nepal: a non-clinical randomised controlled trial approach. DARU J Pharm Sci. 2016;24(1):6.
Sapkota B, Bokati P, Dangal S, Aryal P, Shrestha S. Initiation of the pharmacist-delivered antidiabetic medication therapy management services in a tertiary care hospital in Nepal. Medicine (Baltimore). 2022;101(16): e29192.
Upadhyay DK, Ibrahim MIM, Mishra P, Alurkar VM. Impact assessment of pharmacist-supervised intervention on health-related quality of life of newly diagnosed diabetics: A pre-post design. J Pharm Bioallied Sci. 2020;12(3):234–45.
Samtia A, Rasool M, Ranjha N, Usman F, Javed I. A Multifactorial Intervention to Enhance Adherence to Medications and Disease-Related Knowledge in Type 2 Diabetic Patients in Southern Punjab, Pakistan. Trop J Pharm Res. 2013;12(5):851–6.
Bukhsh A, Nawaz MS, Ahmed HS, Khan TM. A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: A consort compliant study protocol. Medicine (Baltimore). 2018;97(12): e9847.
Ramzan B, Harun SN, Butt FZ, Butt RZ, Hashmi F, Gardezi S, et al. Impact of diabetes educator on diabetes management: findings from diabetes educator assisted management study of diabetes. Arch Pharm Pract. 2022;13(2):43–50.
Rashid Nazir SU, Hassali MA, Saleem F, Haque N. Medication management program: adherence, disease-related knowledge, health-related quality of life, and glycemic control for type 2 diabetes mellitus. Altern Ther Health Med. 2020;26.
Javaid Z, Imtiaz U, Khalid I, Saeed H, Khan RQ, Islam M, 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.
Malik S, Khaliq IH, Mahmood HZ, Khaqan S, Abdullah Y, Rasheed N, et al. Self-management practices among type 2 diabetes patients attending physicians and pharmacists: An exploratory study from Lahore, Pakistan. Ethiop J Health Dev. 2020;34(3).
Malik M, Aslam U, Hussain A, Hashmi A. Impact of Community Pharmacy Diabetes Care Program on Knowledge and Glycemic Control: An Unexplored Opportunity for Community Pharmacists in Pakistan. Int J Diabetes Metab Disord. 2020;5(5):115–23.
Abubakar M, Atif M. Impact of pharmacist-led interventions on diabetes management at a community pharmacy in Pakistan: a randomized controlled trial. Inq J Health Care Organ Provis Financ. 2021; 58:00469580211036283.
Malathy R, Narmadha M, Jose MA, Ramesh S, Babu ND. Effect of a diabetes counseling programme on knowledge, attitude and practice among diabetic patients in Erode district of South India. J Young Pharm. 2011;3(1):65–72.
Adepu R, Rasheed A, Nagavi B. Effect of patient counseling on quality of life in type-2 diabetes mellitus patients in two selected South Indian community pharmacies: a study. Indian J Pharm Sci. 2007;69(4):519–24.
Pawar S, Pawar A. Impact of Structured Diabetes Pharmaceutical Care Training on Practices of Community Pharmacist. J Pharm Pract Community Med. 2020;6(4).
Ghosh S, Rajvanshi A, Kishun S. Assessment the influence of patient counseling on quality of life in type-II diabetes mellitus patients. Int J Pharma Bio Sci. 2010; 3:6.
Sriram S, Chack LE, Ramasamy R, Ghasemi A, Ravi TK, Sabzghabaee AM. Impact of pharmaceutical care on quality of life in patients with type 2 diabetes mellitus. J Res Med Sci. 2011;16(Suppl1): S412.
Tadisetti P, Kishore Kumar Y, Gnana Deepak B, Vivekreddy T, Sharmila Nirojini P, Nadendla RR. A cross sectional study on the cascade activities of clinical pharmacist regarding diabetes mellitus among rural masses near capital city of Amaravathi, Guntur. 2017.
Jayaram A, Vineetha K, Shabaraya AR. Impact of Pharmacist Intervention In Educating Type 2 Diabetes Mellitus Patients Having Lower Medication Adherence To Attain Higher Medication Adherence And Improved Quality Of Life: A Community Based Prospective Interventional Study. Int J Pharm Sci. 2023;1(12):1.
Simon MA, Raja BY, Varughese PC, Daniel LM, Sowjanya K, Sarumathy S, et al. Pharmacist led intervention towards management of type 2 diabetes mellitus and assessment of patient satisfaction of care: a prospective, randomized controlled study. Diabetes Metab Syndr Clin Res Rev. 2021;15(5):102208.
Al Assaf S, Zelko R, Hanko B. The effect of interventions led by community pharmacists in primary care for adults with type 2 diabetes mellitus on therapeutic adherence and HbA1c levels: a systematic review. Int J Environ Res Public Health. 2022;19(10):6188.
Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research. Pharmaceutics. 2021;13(7):1100.
Wibowo MINA, Yasin NM, Kristina SA, Prabandari YS. A systematic review on self-reported questionnaires to assess medication adherence in diabetic patients. Malays J Public Health Med. 2021;21(2):359–73.