Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .
Pharmacist Interventions in the Management of Type 2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials.
BACKGROUND Diabetes mellitus is a major health problem that is growing rapidly worldwide . A collaborative and integrated team approach in which pharmacists can play a pivotal role should be sought when managing patients with diabetes . OBJECTIVE To identify and summarize the main outcomes of pharmacist interventions in the management of type 2 diabetes .  METHODS PubMed , Cochrane Central Register of Controlled Trials , and Web of Science were search ed for r and omized controlled trials evaluating the effectiveness of any pharmacist intervention directed at patients with type 2 diabetes in comparison with usual care . Outcome measures of interest included glycosylated hemoglobin ( Alc ) , blood glucose , blood pressure , lipid profile , body mass index ( BMI ) , 10-year coronary heart disease ( CHD ) risk , medication adherence , health-related quality of life ( HRQoL ) , and economic outcomes . The risk of bias in included studies was assessed using the Cochrane risk of bias tool . RESULTS Thirty-six studies were included in this systematic review , involving 5,761 participants . The studies evaluated the effects of several pharmacist interventions carried out in various countries and in different health care facilities , such as community pharmacies , primary care clinics , and hospitals . The number of studies reporting each outcome of interest varied . Alc was evaluated in 26 studies , of which 24 reported a greater reduction in this outcome in the intervention group compared with the control group , with the difference in change between groups ranging from -0.18 % to -2.1 % . Eighteen studies assessed change in systolic blood pressure , of which 17 studies reported a greater improvement in this outcome in the intervention group , with the difference in change between groups varying between -3.3 mmHg and -23.05 mmHg . For diastolic blood pressure , a greater effect was also observed in the intervention group in 14 out of 15 studies , with the difference in change between groups varying between -0.21 mmHg and -9.1 mmHg . Thirteen studies described total cholesterol as an outcome measure , of which 10 reported a greater improvement in this outcome in the intervention group , with the difference in change between groups ranging from + 18.95 mg dL(-1 ) to -32.48 mg dL(-1 ) . With regard to low-density lipoprotein cholesterol , a greater reduction in this parameter in the intervention group was documented in 12 out of 15 studies , with the difference in change between groups varying between + 7.35 mg dL(-1 ) and -30 mg dL(-1 ) . Similarly , favorable data were reported on high-density lipoprotein cholesterol in the intervention group in 9 out of 12 studies that assessed this outcome , with the difference in change between groups ranging from -5.8 mg dL(-1 ) to + 11 mg dL(-1 ) . Data on triglycerides were also reported in 12 studies , of which 9 reported a greater reduction in triglycerides levels in the intervention group , with the difference in change between groups varying between + 12 mg dL(-1 ) and -62 mg dL(-1 ) . Overall , a beneficial effect on BMI was also described in the intervention group in 12 out of 14 studies . Of note , in all 6 studies that estimated the 10-year CHD risk among study patients , a greater improvement in the intervention group versus the control group was found . In addition , pharmacist interventions also had a positive impact on medication adherence and HRQoL in most studies that ascertained these outcomes . Finally , although only 3 studies conducted a cost-effectiveness analysis , pharmacist interventions proved to be cost-effective . CONCLUSIONS The findings from this review clearly support the involvement of pharmacists as members of health care teams in the management of patients with type 2 diabetes . DISCLOSURES This systematic review was not funded . The authors declare that they have no conflicts of interest . Concept and study design were created by Pousinho , Morgado , and Alves . Pousinho took the lead in data collection , along with Alves , and data interpretation was performed by Pousinho , Falcão , and Alves . The manuscript was primarily written by Pousinho , along with Alves , and revised by Alves , Morgado , and Falcão
Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .