Abstract

Background: Non-adherence to antidiabetic pharmacotherapy remains a primary impediment to achieving target glycemic control and preventing microvascular and macrovascular complications in patients with type 2 diabetes mellitus (T2DM).

Objective: To evaluate the efficacy of structured clinical pharmacist-led comprehensive medication management (CMM) on HbA1c reduction and medication adherence over a 12-month period in ambulatory care settings.

Methods: A prospective, parallel-group, open-label randomized controlled trial was conducted across four academic medical centers. Adult patients (n=384) with poorly controlled T2DM (baseline HbA1c ≥ 8.5%) were randomized 1:1 to receive either standard medical care (control group, n=192) or pharmacist-led CMM interventions involving face-to-face pharmacotherapy consultations, medication reconciliation, regimen simplification, and personalized patient education (intervention group, n=192).

Results: At 12 months, the mean HbA1c reduction was significantly greater in the intervention group compared to standard care (-1.42% ± 0.31% vs. -0.48% ± 0.28%, P < 0.001). Medication adherence measured by the 8-item Morisky Medication Adherence Scale (MMAS-8) improved by 68.4% in the intervention group vs. 21.3% in the control group (P < 0.001). Furthermore, adverse drug events and hypoglycemic episodes were reduced by 41% (relative risk 0.59, 95% CI: 0.44-0.79).

Conclusion: Integration of clinical pharmacists within multidisciplinary ambulatory teams significantly enhances glycemic control, optimizes adherence, and minimizes drug-related problems in high-risk diabetic cohorts.