OBJECTIVES: To systematically assess the impact of pharmacist-delivered MTM services on diabetes related outcomes: hemoglobin A1c (HbA1c), blood glucose, hospitalizations, emergency department visits, and healthcare costs.

METHODS: Searches were carried out through Pubmed, IPA, CINAHL, and PsycInfo in October 2018. The search was limited to those articles in English, studied in humans, and published between January 1, 2007 to October 10, 2018. Search terms for each database were established based on concepts relevant to achieving the objective, including diabetes, clinical outcomes, pharmacist/pharmacy, and medication therapy management. References of included full-text articles were hand searched, and grey literature was searched through Clinicaltrials.gov.

RESULTS: A total of 284 articles were identified through the initial search. After eligibility criteria were applied, 15 articles were included in the final qualitative synthesis of evidence. Study designs included observational, pilot, and randomized controlled trials. Majority (n=12) of the studies measured HbA1c as study outcome, and other outcomes included fasting plasma glucose (FPG), fasting blood glucose (FBG), postprandial glucose (PPG), hospitalizations, and cost. Overall, pharmacist-led MTM services resulted in improved diabetes-related outcomes. The reduction in HbA1c ranged from 0.19% to 3.56%. Patients with more severe diabetes (higher HbA1c) accounted for the larger reductions in HbA1c compared to patients with less severe diabetes. Blood glucose values were improved by 14 mg/dL for FPG, 6 mg/dL for FBG, and 14 mg/dL for PPG. Diabetes-related hospitalizations decreased by 52% due to MTM implementation. Additionally, annual costs were reduced due to MTM programs ($1031 per patient) and medication changes initiated by pharmacists through MTM ($166.20 for the patient and $163.08 for the health plan).

CONCLUSIONS: Pharmacist-led MTM services have shown promising improvements in diabetes outcomes; in particular, patients with higher HbA1c benefited more from MTM services.