(B-054) Impact of Pharmacist-Led Medication Therapy Management on Type 2 Diabetes Mellitus in Outpatient Settings: A Systematic Review and Meta-Analysis

Background: Achieving optimal glycemic control in type 2 diabetes mellitus (T2DM) remains challenging despite available therapies. Pharmacist-led medication therapy management (MTM) can improve diabetes outcomes by optimizing medication use and providing continuity of care in outpatient settings.

Objectives: To systematically evaluate the impact of pharmacist-led MTM services compared to usual care (i.e., no MTM) in outpatients with T2DM.

Methods: A systematic review and meta-analysis were conducted using PubMed, EMBASE, Scopus, and Web of Science databases from inception to January 2025. Studies were included if they enrolled adults (≥18 years) with HbA1c >7%, received at least one pharmacist-led MTM consultation, and had a comparator group receiving no MTM or pre-MTM data. Studies involving pharmacy students-led MTM were excluded. A total of 25 studies met the inclusion criteria (RCTs = 10, cohort studies = 9, non-RCTs = 6). Primary outcomes included HbA1c and fasting blood sugar (FBS) reduction, while secondary outcomes included medication adherence, patient knowledge, and self-care activities. Quality assessment was performed using the Cochrane Risk of Bias tool (CROB) for RCTs, Risk Of Bias In Non-randomized Studies - of interventions (ROBINS-I) for non-RCTs, and the Newcastle–Ottawa Scale (NOS) for cohort studies. Publication bias was assessed using funnel plots.

Results: Pharmacist-led MTM interventions were associated with significant reductions in HbA1c (22 studies) and FBS (9 studies). Medication adherence (8 studies), patient knowledge (4 studies), and self-care activities (3 studies) also significantly improved. Meta-analysis of 7 RCTs including 1178 participants (n=580 cases and 598 controls) showed a significant HbA1c reduction (-0.69 [-0.11, -0.27]; p=0.001) in the MTM group compared to usual care. Subgroup analysis also showed similar HbA1C levels for all 3, 6, and> 12-month periods. Similarly, the meta-analysis of 6 non-RCT studies with 2544 participants showed a more significant HbA1c reduction (-2.77 [-4.30, -1.23]; p=0.0004) in the post-test (MTM group) when compared to the pre-test (usual care) group. Subgroup analysis also showed similar HbA1C levels for all 3,6, and> 12-month periods. Most RCTs had a low-to-moderate risk of bias, with blinding as a limitation. Non-RCTs showed moderate risk, mainly due to confounding and missing data. Cohort studies were moderate to good quality but lacked comparability in some cases.

Conclusions: Pharmacist-led MTM services significantly improve glycemic control, medication adherence, and patient knowledge in T2DM patients in outpatient settings. Further studies are needed to assess patient satisfaction, quality of life, and healthcare utilization.