(B05) Effectiveness of Medication Therapy Management in Older Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Publication Number: 617

Background: Medication Therapy Management (MTM) is a service provided by pharmacists or other healthcare professionals with the goal of maximizing clinical outcomes for patients with chronic conditions. Older adults with type 2 DM frequently have co-morbid conditions and are prescribed with many drugs that may result in medication therapy issues (MTPs) obstructing the intended therapeutic effects.

Objectives: To assess the efficacy of medication therapy management vs standard care in older adults with type 2 diabetes

Methods: The systematic review was reported according to PRISMA guidelines. A systematic search was conducted in PubMed, EMBASE, and CINAHL to identify randomized controlled trials (RCTs) assessing the Medication Therapy Management in patients aged ≥ 60 years with diabetes compared with standard of care that were published in English between January 1, 2005, and July 31, 2022. Data on study design, study duration, type of intervention and comparators along with baseline data of desired glycemic outcomes such as HbA1c, systolic and diastolic blood pressure, lipid profile, and adherence to the treatment regimen were extracted. Follow up data of above-mentioned outcomes were extracted based on the duration of follow up i.e., 3,6,9,12,18 months. The risk of bias was carried out using Cochrane risk of bias tool. A sub-group analysis was carried out for Mode of Intervention and the Intervention provider. The meta-analysis was carried out using Revman5.3.

Results: A total of 4427 articles were extracted from the databases and two studies were found by hand searching out of which 42 articles were included for systematic review. Included studies had intervention in the form of education either by healthcare professionals in person (HCP) (35 studies) or with the help of telecommunication/electronic devices (7 studies). Intervention was provided by physician (7 studies), nurse (11 studies), pharmacist (15 studies), dietician or any other healthcare professionals (8 studies), or trained diabetes educators (1 study). Assessment of risk of bias concluded that high risk was observed in attrition bias, unclear risk in allocation concealment and low risk in reporting the outcomes. The data was pooled across RCTs, Medication Therapy Management was associated with improved glycemic control in percentage (MD: -0.38 [95%CI: -0.48, -0.29]; I2=74%) and diastolic blood pressure in mmHg units (MD: -1.84 [95%CI: -2.94, -0.73]; I2:90%). In contrast, improved adherence was observed in the control group (OR: 3.97[95% CI:1.54,10.27]). Results of sub-group analysis showed that face-to-face intervention (MD: -0.43 [95%CI: -0.54, -0.32]; I2:74%) by any HCP (MD: -0.37 [95%CI: -0.45, -0.29]; I2:72%) showed better results.

Conclusions: Medication Therapy Management in older adults with diabetes may be considered as an effective approach to improve adherence and improve glycemic control and cardiovascular risk factors.