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Meta-Analysis
. 2020 Jan 31;18:eRW4686.
doi: 10.31744/einstein_journal/2020RW4686. eCollection 2020.

Pharmaceutical Care-Based Interventions in Type 2 Diabetes Mellitus : A Systematic Review and Meta-Analysis of Randomized Clinical Trials

[Article in English, Portuguese]
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Free PMC article
Meta-Analysis

Pharmaceutical Care-Based Interventions in Type 2 Diabetes Mellitus : A Systematic Review and Meta-Analysis of Randomized Clinical Trials

[Article in English, Portuguese]
Marcel Nogueira et al. Einstein (Sao Paulo). .
Free PMC article

Abstract

Objective: To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus .

Methods: PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis.

Results: Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042).

Conclusion: Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.

Objetivo: Identificar o impacto das intervenções providenciadas pelo cuidado farmacêutico no diabetes mellitus tipo 2.

Métodos: Buscas por ensaios clínicos randomizados controlados foram realizadas nas bases PubMed®, Cochrane e Web of Science . Foram incluídos estudos publicados entre 2012 e 2017, que avaliaram o impacto do cuidado farmacêutico no diabetes mellitus tipo 2. A hemoglobina glicada foi o desfecho primário, e os secundários foram pressão arterial, triglicérides e colesterol. O modelo de efeitos aleatórios foi utilizado na metanálise.

Resultados: Foram incluídos 15 estudos envolvendo 2.325 participantes. A metanálise demonstrou heterogeneidade elevada (I2>97%; p<0,001), redução nos níveis de hemoglobina glicada (-1,07%; IC95%: -1,32; -0,83; p<0,001), glicose (-29,91mg/dL; IC95%: -43,2; -16,6; p<0,001), triglicérides (19,8mg/dL; IC95%: -36,6; -3,04; p=0,021), pressão arterial sistólica (-4,65mmHg; IC95%: -8,9; -0,4; p=0,032) e aumento do colesterol HDL (4,43mg/dL; IC95%: 0,16; 8,70; p=0,042).

Conclusão: As intervenções clínicas e educacionais providenciadas pelo cuidado farmacêutico têm impacto significativo no diabetes mellitus tipo 2. Ferramentas como o Summary of Diabetes Self-Care Activities e a Morisky Medication Adherence Scale podem ser úteis no acompanhamento dos pacientes.

Figures

Figure 1
Figure 1. Study selection flowchart
HbA1c: Glycated hemoglobin.
Figure 2
Figure 2. Risk of bias
Figure 3
Figure 3. Forest plot
Figura 1
Figura 1. Fluxograma de seleção dos estudos
HbA1c: hemoglobina glicada.
Figura 2
Figura 2. Risco de viés
Figura 3
Figura 3. Forest plot

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