Journal of Pharmacy And Bioallied Sciences

: 2019  |  Volume : 11  |  Issue : 4  |  Page : 299--309

A review of pharmacist-led interventions on diabetes outcomes: An observational analysis to explore diabetes care opportunities for pharmacists

Muhammad Z Iqbal1, Amer Hayat Khan2, Muhammad S Iqbal3, Syed Azhar Syed Sulaiman2,  
1 Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, AIMST University Malaysia, Bedong, Kedah Darul Aman, Malaysia
2 Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
3 Associate Professor, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia

Correspondence Address:
Dr. Muhammad Z Iqbal
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, AIMST University, 08100, Bedong, Kedah Darul Aman


A strict and adherence treatment is required by the patient with diabetes mellitus and it demands a proper self-medication by the patient. Pharmacists are involved in providing self-management support to the patients. This review evaluates the interventions of pharmacist for patients to improve self-management with diabetes mellitus and also to improve the clinical outcomes of diabetes mellitus. A comprehensive literature search was performed by using different keywords “pharmacist-led intervention,” “diabetes,” “effect of pharmacist on outcome of diabetes,” and “self-management of diabetes” with the help of various electronic databases such as PubMed, Science Direct, Embase, Web of Science, and the Cochrane Library from the beginning of the database through September 2018. The primary outcome was glycated hemoglobin (HbA1c), whereas the secondary outcomes were blood glucose level, blood pressure (BP) measure, body mass index, lipids, adherence to medication, and quality of life. Twenty-five studies comprising 2997 diabetic patients were included in the analysis. Pharmacist-led intervention was involved in all included studies in the form of education on diabetes and its complications, medication adherence, lifestyle, and education about self-management skills. Pharmacist-led interventions are able to reduce HbA1c levels with a mean of 0.75%. Most studies do not expose the material and methods used in pharmacist-led intervention. The variation in the reduction of HbA1c, fasting blood sugar, BP, and lipid profile was due to the lack of this standardization. The included studies indicated that pharmacist-led interventions in diabetes mellitus can significantly improve the outcomes of diabetes mellitus and its complication later on. Hence, these long-term improvements in outcomes added more value of pharmacists in health-care system of the world.

How to cite this article:
Iqbal MZ, Khan AH, Iqbal MS, Syed Sulaiman SA. A review of pharmacist-led interventions on diabetes outcomes: An observational analysis to explore diabetes care opportunities for pharmacists.J Pharm Bioall Sci 2019;11:299-309

How to cite this URL:
Iqbal MZ, Khan AH, Iqbal MS, Syed Sulaiman SA. A review of pharmacist-led interventions on diabetes outcomes: An observational analysis to explore diabetes care opportunities for pharmacists. J Pharm Bioall Sci [serial online] 2019 [cited 2020 Feb 17 ];11:299-309
Available from:

Full Text


Diabetes mellitus is a complicated metabolic disorder. The management of diabetic mellitus is very difficult and it became a persisted task all over the world. The prevalence of type 2 diabetes is continuously increasing throughout the globe.[1] The risk of diabetes incidence/progression in adults is more in developing countries such as in Malaysia.[2] The National Health and Morbidity Survey (NHMS) Malaysia 2011 reported diabetes prevalence more than 20.8% in the age of 30 years and above.[3] The development of diabetic microvascular and macrovascular complications is usually due to poor control of diabetes mellitus. Proper glycemic control plays a vital role in decreasing the chances to develop complications in patients.[4],[5],[6] In order to achieve the targeted glycemic control, the patient awareness and compliance toward the treatment is really important.[7]

Patient-oriented management interventions led by physicians, pharmacist, nurses, dieticians, and diabetes educators have been proven to improve the outcomes among patients with diabetes.[8],[9],[10] The awareness and compliance toward the treatment of diabetes can be increased by giving proper counseling to the patient with the help of health-care providers: physicians, nurses, and pharmacists.[11],[12],[13],[14] Looking into the past, numerous reviews have proven that the contribution of pharmacists in achieving better control of diabetes is significant.[14],[15],[16] These reviews focused on many types of pharmacist interventions including self-care-related interventions, adherence, and compliance or on counseling but always resulted in a significant effect on the outcomes of diabetes mellitus.

In Malaysia, a pharmacist is keenly involved in patient counseling.[10] The Malaysian picture concerning about the management of diabetes mellitus and the future projections to decrease its prevalence, Health ministry identified the improved management of diabetes as a key strategic priority. Within the Malaysia, there is currently a policy to use clinical pharmacists more efficiently in all tertiary hospitals in the form of DMTAC (Diabetes Medication Therapy Adherence Clinic) department. It was established in 2014 to improve the clinical outcomes of diabetes in the presence of clinical pharmacist.[10]

Recently published studies reveal that pharmacist intervention can improve the outcome of the disease in the form of glycated hemoglobin (HbA1c), fasting blood sugar (FBS), body mass index (BMI), cardiovascular (CV) incidences, blood pressure (BP) measure, and lipid profile.[8],[9],[12] To date, however, no systematic reviews have focused on the effectiveness of DMTAC department and pharmacist-led intervention in Malaysia on the outcome of the disease in the form of HbA1c, FBS, BMI, CV incidences, BP measure, and lipid profile. The main aim of this narrative and systematic review is to evaluate the effectiveness of pharmacist-led interventions on clinical outcomes of diabetes mellitus and prevention of diabetes-related complications in patients.

 Materials and Methods

Study design

The guidance for this review study was taken from Cochrane Handbook and it is in line with the preferred reporting items for systematic reviews and meta-analyses statement. Keywords used to find database studies were as follows: “diabetes,” “pharmacist-led intervention,” “intervention,” and “randomized controlled trial.” Databases used included the PubMed, Web of Science, ScienceDirect, ProQuest, Scopus, and Ovid MEDLINE. Searches were restricted to English language and type 1 and type 2 diabetes mellitus articles only which were published from January 2012 to September 2018. The facts and results from the search are presented as a narrative review.

Inclusion criteria

The inclusion criteria of the study were as follows:

If the study population was diagnosed with diabetes mellitus other than gestational diabetes mellitus (GDM).

If the involvement of pharmacist, or a member of the pharmacy team, is there to do intervention.

If the data on one or more outcome measures were reported, for example, HbA1c in both the control and intervention groups.

If the study design was a randomized controlled trial.

The full original research was published in English.

If the study was original study and published in a peer-reviewed journal.

Exclusion criteria

The exclusion criteria of the study were as follows:

Studies contain patients with GDM.

Non-pharmacist interventions.

If the study design was not a randomized controlled trial.

The full original research that was not published in English.

Data extraction

The data that were extracted from the studies include demographic features, study participants, follow-up dates and times, and number and duration of follow-up pre- and post-interventions. The description of the intervention includes counseling on diabetes education, quality of life, medication details, lifestyle, patient compliance toward the treatment, and clinical outcomes (HbA1c, fasting and random blood glucose levels, BP, BMI, and lipid profile).

The biasness risk in original research studies was measured with the Cochrane risk-of-bias tool (RoB 2.0). This assessment was verified again by researchers and co-researchers by measuring the risk of bias in original research studies. Any divergences were deliberated till consensus was reached.

Data synthesis and analysis

Pharmacist interventions were evaluated in all the included studies. Outcomes in the form of HbA1c, random and fasting glucose levels, BP, BMI, and lipid profiles were evaluated in all included studies. The results for these outcomes were combined and presented in a meta-analysis.

Meta-analyses were accomplished with the help of Review Manager 5.3 via a random effects model as clinical heterogeneity was there in included studies. Subgroup analyses were also conducted for the outcomes such as HbA1c, follow-up time, and baseline HbA1c 7% to explain any heterogeneity (I2) and to explore key intervention components in all the studies. Sensitivity analyses were conducted to check the strength of the results for included studies with a group randomization design and studies with a high risk of biasness which can affect the outcome, that is, HbA1c.

Results for all the outcomes in the form of HbA1c, FBS, BMI, CV incidences, BP measure, and lipid profile were described accordingly.


From the E-database searches, a total of 5828 studies were identified. Of these, 3889 were categorized as unique studies. After the initial screening by title and abstract, 3820 references were omitted as they were not found in line with the inclusion criteria. The full texts of 59 papers were evaluated, and finally 25 papers were included in the review process. See [Figure 1] for extended data extraction information.{Figure 1}

The main characteristics and study population along with outcomes of the included studies are presented in [Table 1].{Table 1}

All the included studies were randomized controlled trials. Out of included 25 studies, six studies were published in 2016, four in 2011, four in 2012, three in 2013, three in 2010, two in 2017, and one in 2009, 2016, and 2018 each. Five studies were conducted in Malaysia followed by five studies in the USA. Two studies were conducted in Jordan and two in Iran, followed by one in Pakistan, Cyprus, the United Kingdom, Belgium, Hong Kong, Portugal, Nigeria, Brazil, and China each. All studies focus on type 2 diabetes mellitus. The study duration for most of the studies was 1 year, followed by 6 months, 5 months, and 9 months. The minimum follow-up was two visits, whereas the maximum follow-up was eight visits.


In all the included studies, the interventions were provided by trained pharmacist alone or by the department of pharmacy. Most of the included studies targeted individual diabetic patients. On the other hand, one of the included studies did not specify about the intervention, either it was offered by individual pharmacist or by the department of pharmacy.[26] Some of the included studies reported personalized kind of interventions that were based on specific needs of diabetic patients.[23],[25],[26],[30],[31],[32],[34]

The type, intensity, and frequency of interventions were different in all the included studies. The number of visits for face-to-face interactions was also different in all the included studies. The variation was from once in a week to once in a year.

Some of the included studies do have face-to-face contact with the pharmacists or pharmacy departments[9],[10],[11],[12] and some have combination of face-to-face contacts along with telephone contact with the pharmacists or department of pharmacy.[25],[27]

Fifteen included studies used patient education about diabetes as interventions; the diabetes education was either in the form of general information about disease or about short-term and long-term diabetic complications. Patient education on medication was as given by pharmacists in 13 included studies and this education was to increase the adherence of patients, decrease dosage of drug-related problems, storage, and proper use of the medicines.

In the 19 included studies, education was given on lifestyle modification, exercise requirements, foot cares, management of proper diet and smoking termination were the important part of the intervention by the pharmacists.

Various kinds of clinical outcome measurements were reported in all the included studies [Table 1]. The clinical outcomes of the disease were in the form of HbA1c, FBS, BMI, BP measurements, Modified Morisky Medication Adherence Scale (MMMAS) scores, patient-reported medication adherence, lipid profile, and quality of life. The analysis shows generally a significant improvement in HbA1c, with the mean reduction of 0.75%. The effects on other outcomes were also significant.

Various guidelines for diabetes recommend that a target HbA1c of a diabetic patient should be 7% or less, but Malaysian guideline recommends that the targeted HbA1c for diabetic patients should be equal or less than 6.3% (Clinical Practice Guideline for Management of T2DM, Malaysia 2015). In order to decrease the chances of diabetic complication in those patients who have HbA1c more than 7%, it is recommended to reduce the HbA1c up to 1% or more. Similar results were reported by United Kingdom prospective diabetes study trial. Thus, a tight control of FBS and random blood sugar (RBS) is needed to decrease diabetes complications.[36] Thus, pharmacist intervention is needed to reduce the FBS and RBS of patients as shown in the included studies of analysis.[9],[12],[19],[21],[22],[23],[25],[27],[28],[29],[32],[34]

Adherence of patients toward medication was measured in seven studies.[10],[12],[13],[17],[18],[32],[33] MMMAS was used in three studies.[10],[12],[17] All studies show that the improvement was seen in the control of the disease between intervention groups as compared with the control group.

Twelve included studies[9],[11],[19],[21],[22],[25],[27],[28],[29],[30] measure the effect of intervention on the BP of the patients. Of these studies, only two reported no effect of pharmacist intervention on the control of BP of the patients.[19],[35] The American Association of Clinical Endocrinologists and American College of Endocrinology CPGs on diabetes recommends that the target BP of diabetics should be less than 140/80–90mm Hg to decrease the chances of complications.[34] According to Malaysia guideline, the BP should be less than 150/85mm Hg in diabetic patients to decrease the risk of microvascular and macrovascular complications.[25] On the other hand, Australian guideline recommends this target 130/80mm Hg or lower and if patients are having proteinuria with diabetes then it should be less than 125/75mm Hg. Diabetes guidelines from Australia, USA, and Malaysia recommend to decrease the daily sodium intakes, increase potassium intakes, and moderate intakes of alcohol in patients with diabetes mellitus.[11],[35] These guidelines recommend prescribing of an Angiotensin Converting Enzyme Inhibitor or Angiotensin Receptor Blocker unless contraindicated, as the preferred antihypertensive in patients with diabetes mellitus in comorbidity of hypertension.[37],[38]

Only two included studies[12] measure and compare the quality of life of diabetic patients in both the control and intervention groups. From these two studies, one study used validated EQ-5D(3L) questionnaire,[12] whereas the other study used the validated Brazilian version of Diabetes Quality of Life Measure.[34] Because of using different versions of the questionnaire to measure the quality of life of diabetic patients and also differences in reporting strategies, it was not possible to pool the results. Both studies were reported to be significantly improving the quality of life of patients from the used questionnaires.

Thirteen included studies measure the lipid profile of the patients.[11],[12],[17],[19],[21],[22],[25],[27],[29],[30],[31],[32],[35] Most of the studies reported the improvement in lipid profile in intervention group, whereas only four[12],[17],[30],[31] studies showed no effect of the intervention in the intervention group. Guidelines of various countries such as Australia, UK, USA, and Malaysia strongly recommend the use of a lipid-profile control medication such as a statin if it is not contraindicated to decrease the risk of cardiovascular disease (CVD) development.[36] Although the chances of development of diabetes with statin use are reported,[38],[39] many meta-analyses on randomized trials reported the advantages of statins to decrease the CV risks.[16],[37],[40]

Four of the included studies measure the CV risk factors in diabetic patients.[11],[18],[19],[32] These studies reported a significant reduction in CV risk factors in diabetic patients after pharmacist intervention. European, American, and Malaysian guidelines recommend the initiation of aspirin therapy (75–162mg/day) for primary preventative approach to decrease the CVD risks.[7],[41],[42],[43] In Australia, Framingham risk equation was developed for calculating the absolute CVD risk.[44] The US guidelines recommend the use of the Framingham risk score to calculate the risk of CVDs. Framingham risk score can calculate the percentage of CVD risk in 10 years with the help of demographic data of the patients’, that is, family history of CVD, gender, total cholesterol level, and high-density lipoprotein cholesterol level of the patients.[44]

 Strengths and Limitations

This review contains numerous strengths. All of the included studies reported the measurement of HbA1c values pre- and post-intervention by pharmacist, owing to that it was easy to measure and compare the effect of the pharmacist interventions in a meta-analysis. Similarly, the results for FBS, RBS, BP measurement, BMI, and lipid profiles can easily be pooled in meta-analyses. Although most of the included studies used different strategies to observe the effect of pharmacist intervention, a few studies directly measured the self-management. The results of these included studies show a direct positive relation between the pharmacist intervention and control of the disease. It is because the most of the interventions already addressed all common drug-related problems of diabetic patients.[45],[46]

This study includes certain limitations as well. The types and method of used interventions and study results were very incomplete in some of the studies.[18],[23],[24],[26],[27],[29],[30],[31],[33],[34],[35] It can result into the biasness in the study. However, the risk of biasness will not change the results of meta-analysis in HbA1c values. All the used interventions can be combined together to make a complex and perfect intervention, because all used interventions in included studies contained multiple useful components. This review shows all those multiple interventions resulted in a positive impact on the outcomes of diabetes mellitus. More refined analyses, such as meta-regression analyses, could have given more understanding about the main components.[47] However, due to the limited number of studies and also the type of available data from the included studies, it was not possible. Although we have provided different components of pharmacist interventions from different included studies, the ideal composition of pharmacist-led intervention is not available yet.


The review reveals the pharmacist’s contribution in improving the self-management support and awareness in patients with diabetes. This narrative review has highlighted the various factors involved to achieve the target therapy outcomes. Overall, pharmacist interventions have a positive effect on the outcomes of diabetes mellitus. Furthermore, pharmacist intervention in diabetic patients can be resulted in the better control of disease and its complications, and it can help to improve the quality of life of the patients.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1World Health Organization. World health statistics 2016: monitoring health for the SDGs sustainable development goals. World Health Organization; 2016.
2Paz-Pacheco E Diabetes Clinical Practice Guidelines (CPGs) for the ASEAN region: country initiatives for collectively enhanced diabetes care in the region. J ASEAN Federation Endocrine Soc2014;26:36.
3Institute for Public Health. National Health and Morbidity Survey Malaysia 2011 (NHMS 2011). Vol. III: Healthcare demand and out-of-pocket health expenditure. 2011.
4Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-12.
5Maji D Prevention of microvascular and macrovascular complications in diabetes mellitus. J Indian Med Assoc2004;102:426-8.
6Iqbal MZ, Khan AH, Sulaiman SA, Iqbal MS, Hussain Z Guideline for adherence and diabetes control in co-morbid conditions in a tertiary hospital in Malaysia. Trop J Pharm Res 2014;13:1739-44.
7Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. American Association of Clinical Endocrinologists and American College of Endocrinology––clinical practice guidelines for developing a diabetes mellitus comprehensive care plan-2015. Endocr Pract 2015;21:1-87.
8Lau BT, Ismail SZ, Ng SY, Mohmmad N Impact of pharmacist-led diabetes program on glycated hemoglobin and diabetes-related hospitalizations in a district-level hospital: a pilot retrospective cohort study. Int J Adv Life Sci Res 2018;1:26-36.
9Lim PC, Lim K, Embee ZC, Hassali MA, Thiagarajan A, Khan TM Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia. Pak J Pharm Sci 2016;29:595-601.
10You LX, Selvadurai S, Yee CK, Noh NB, Bao GC, Joyce T, et al. Impact of pharmacist-managed diabetes medication therapy adherence clinic (DMTAC) in government health clinics. Malays J Pharm Sci 2015;13:43.
11Adibe MO, Obinna UP, Uchenna IN, Michael UC, Aguwa CN Effects of an additional pharmaceutical care intervention versus usual care on clinical outcomes of Type 2 diabetes patients in Nigeria: a comparative study. Sci Res Essays 2014;9:548-56.
12Butt M, Mhd Ali A, Bakry MM, Mustafa N Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: a randomised controlled study. Saudi Pharm J 2016;24:40-8.
13Nascimentoa T, Braz N, Gomes E, Fernandez-Arche A, De La Puerta R Self-care improvement after a pharmaceutical intervention in elderly type 2 diabetic patients. Curr Diabetes Rev 2015;12:120-8.
14van Eikenhorst L, Taxis K, van Dijk L, de Gier H Pharmacist-led self-management interventions to improve diabetes outcomes: a systematic literature review and meta-analysis. Front Pharmacol 2017;8:891.
15Hassali MA, Nazir SU, Saleem F, Masood I Literature review: pharmacists’ interventions to improve control and management in type 2 diabetes mellitus. Altern Ther Health Med 2015;21:28-35.
16Rajpathak SN, Kumbhani DJ, Crandall J, Barzilai N, Alderman M, Ridker PM Statin therapy and risk of developing type 2 diabetes: a meta-analysis. Diabetes Care 2009;32:1924-9.
17Lim PC, Lim K Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic. Pharm Pract 2010;8:250-4.
18Samtia AM, Rasool MF, Ranjha NM, Usman F, Javed I A multifactorial intervention to enhance adherence to medications and disease-related knowledge in type 2 diabetic patients in Southern Punjab, Pakistan. Trop J Pharm Res 2013;12:851-6.
19Chan CW, Siu SC, Wong CK, Lee VW A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes. J Cardiovasc Pharmacol Ther 2012;17:57-64.
20Jameson JP, Baty PJ Pharmacist collaborative management of poorly controlled diabetes mellitus: a randomized controlled trial. Am J Manag Care 2010;16:250-5.
21Ali M, Schifano F, Robinson P, Phillips G, Doherty L, Melnick P, et al. Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study. Diabet Med 2012;29:e326-33.
22Mourão AO, Ferreira WR, Martins MA, Reis AM, Carrillo MR, Guimarães AG, et al. Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial. Int J Clin Pharm 2013;35:79-86.
23Kraemer DF, Kradjan WA, Bianco TM, Low JA A randomized study to assess the impact of pharmacist counseling of employer-based health plan beneficiaries with diabetes: the EMPOWER study. J Pharm Pract 2012;25:169-79.
24Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, et al. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. J Clin Pharm Ther 2011;36:602-13.
25Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Pharm 2012;18:516-26.
26Farsaei S, Sabzghabaee AM, Zargarzadeh AH, Amini M Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: a randomized controlled trial. J Res Med Sci 2011;16:43-9.
27Cohen LB, Taveira TH, Khatana SA, Dooley AG, Pirraglia PA, Wu WC Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ 2011;37:801-12.
28Shao H, Chen G, Zhu C, Chen Y, Liu Y, He Y, et al. Effect of pharmaceutical care on clinical outcomes of outpatients with type 2 diabetes mellitus. Patient Prefer Adherence 2017;11:897-903.
29Taveira TH, Dooley AG, Cohen LB, Khatana SA, Wu WC Pharmacist-led group medical appointments for the management of type 2 diabetes with comorbid depression in older adults. Ann Pharmacother 2011;45:1346-55.
30Taveira TH, Friedmann PD, Cohen LB, Dooley AG, Khatana SA, Pirraglia PA, et al. Pharmacist-led group medical appointment model in type 2 diabetes. Diabetes Educ 2010;36:109-17.
31Wishah RA, Al-Khawaldeh OA, Albsoul AM Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: randomized controlled trial. Diabetes Metab Syndr 2015;9:271-6.
32Korcegez EI, Sancar M, Demirkan K Effect of a pharmacist-led program on improving outcomes in patients with type 2 diabetes mellitus from northern Cyprus: a randomized controlled trial. J Manag Care Spec Pharm 2017;23:573-82.
33Jahangard-Rafsanjani Z, Sarayani A, Nosrati M, Saadat N, Rashidian A, Hadjibabaie M, et al. Effect of a community pharmacist-delivered diabetes support program for patients receiving specialty medical care: a randomized controlled trial. Diabetes Educ 2015;41:127-35.
34Cani CG, Lopes LD, Queiroz M, Nery M Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital. Clinics 2015;70:102-6.
35Doucette WR, Witry MJ, Farris KB, McDonough RP Community pharmacist-provided extended diabetes care. Ann Pharmacother 2009;43:882-9.
36Iqbal MZ, Iqbal MS, Nicholas D, Awang J, Khan AH, Sulaiman SA Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia. Int Curr Pharm J 2014;3:309-12.
37Iqbal MZ, Iqbal MS, Khan AH, Sulaiman SA, Iqbal MW Guideline adherence and control of diabetes mellitus with co-morbidities in a tertiary-care hospital in Malaysia. Value Health 2014;17:A353.
38Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010;375:735-42.
39Liew SM, Lee PY, Hanafi NS, Ng CJ, Wong SS, Chia YC, et al. Statins use is associated with poorer glycaemic control in a cohort of hypertensive patients with diabetes and without diabetes. Diabetol Metab Syndr 2014;6:53.
40Pradhan A, Libby P Cardiovascular benefits and diabetes risks of statin therapy in primary prevention. Lancet2012;380:565-71.
41Cho NH, Colagiuri S, Distiller L, Dong B, Dunning T, Gadsby R, et al. International Diabetes Federation: global guideline for managing older people with type 2 diabetes. Brussels, Belgium: International Diabetes Federation; 2013.
42Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:140-9.
43Lalor E National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk; 2012. Available from:
44D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117:743-53.
45Haugbølle LS, Sørensen EW Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma-interviewing patients at home. Pharm World Sci 2006;28:239-47.
46Kempen TGH, van de Steeg-van Gompel CH, Hoogland P, Liu Y, Bouvy ML Large scale implementation of clinical medication reviews in Dutch community pharmacies: drug-related problems and interventions. Int J Clin Pharm 2014;36:630-5.
47Guise JM, Butler ME, Chang C, Viswanathan M, Pigott T, Tugwell P, et al. AHRQ series on complex intervention systematic reviews—paper 6: PRISMA-CI extension statement and checklist. J Clin Epidemiol 2017;90:43-50.