Pharmacist-led comprehensive medication management significantly reduced HbA1c (-1.05 mmol/L; p<0.001), systolic blood pressure, and LDL in patients with type 2 diabetes and chronic kidney disease.
Does pharmacist-led comprehensive medication management improve cardiometabolic outcomes (SBP, LDL, HbA1c) and guideline-directed therapy adherence in adults with type 2 diabetes and chronic kidney disease?
Pharmacist-led comprehensive medication management significantly improves cardiometabolic surrogate markers and increases the utilization of guideline-directed medical therapies in patients with T2D and CKD.
Absolute Event Rate: -1.05% vs 0.09%
p-value: p=<0.001
Objective: Rapidly changing guidelines and escalating therapeutic complexity have underscored the need for systematic medication optimization in cardiometabolic care. Comprehensive medication management (CMM) entails an individualized evaluation of all medications, assessing appropriateness, efficacy, safety, and adherence and may be particularly beneficial in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). This study evaluates CMM's impact on key clinical outcomes (systolic blood pressure (SBP), LDL, HbA1c) and its alignment with guideline-directed therapy for T2D, CKD, hypertension (AH), and hyperlipidemia (HLP). Design and method: A prospective, non-randomized pre–post interventional study was conducted at the Health Center Zagreb - Centar (May 2023 – September 2025). Eligible adults with T2D, documented eGFR <60 mL/min/1.73m2, and minimum 6-month follow-up were enrolled. The intervention group (IG) received standard care plus pharmacist-led-CMM, while the control group (CG) continued with standard general practitioner management only. Data collected included sociodemographics, clinical parameters, and medication profiles, with serial assessments of T2D, HLP, and AH control. Results: The IG (n=47) demonstrated superior SBP/lipid/glucose control: HbA1c (-1.05 ± 1.13 mmol/L; p<0.001), SBP (-13 0, -19 mmHg; p<0.001), LDL (-0.36 0, -0.9 mmol/L; p=0.002). In the CG (n=46), HbA1c (0.09 ± 1.37; p=0.668) and LDL (0.08 ± 0.78; p=0.395) remained unchanged, while SBP decreased significantly (-6 -2,-25; p=0.004). Target achievement improved significantly in IG (AH 25% to 42%, HLP 19.6% to 47.7%, and T2D 30.4% to 72.7%), whereas CG showed significant T2D improvement only (39.1% to 54.3%). Guideline-directed therapy implementation improved significantly in the IG: GLP-1RA use increased from 17.0% to 21.3% (p<0.001), SGLT2i from 36.2% to 63.8% (p<0.001), and metformin from 38.3% to 55.3% (p=0.011). MRA use increased from 40.4% to 48.9%, but not statistically significant (p=0.542). CG showed modest increases in GLP-1RA (19.6% to 23.9%; p=0.083) and SGLT2i use (23.9% to 30.4%; p=0.083), but a significant increase in MRA use (8.7% to 15.2%; p<0.001). Metformin use slightly declined (66.7% to 64.4%; p=0.655). Conclusions: Pharmacist integration within multidisciplinary cardio-renal-metabolic care pioneers new pharmacological horizons and positions CMM as a foundational strategy for implementing guideline-directed therapy in complex cardiometabolic disease phenotypes.
Orehovački et al. (Fri,) conducted a other in Type 2 diabetes and chronic kidney disease (n=93). Pharmacist-led comprehensive medication management (CMM) vs. Standard general practitioner management was evaluated on Change in HbA1c (mmol/L) (p=<0.001). Pharmacist-led comprehensive medication management significantly reduced HbA1c (-1.05 mmol/L; p<0.001), systolic blood pressure, and LDL in patients with type 2 diabetes and chronic kidney disease.