Drug related problems in type-2-diabetes mellitus with and without cardiovascular diseases: A systematic review and meta-analysis

Background: Drug related problems (DRPs) are more prevalent among the type-2-diabetes mellitus (T2DM) patients especially because of related comorbidities and polypharmacy. Objective: We aimed to quantify the prevalence of different types of DRPs among the T2DM patients with or without cardiovascular diseases (CVD) through a systematic review. Methods: PubMed/MEDLINE, Scopus and the Cochrane Library were searched to identify the literature till September 2019 from inception. Reference list of all included studies were also searched for additional relevant studies. Studies which assessed the DRPs in T2DM patients with or without CVD published in English language were included in our review. Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields were used to check the risk of bias. Two authors were independently involved in study selection, data extraction and quality assessment of the studies and disagreements were resolved by reconciliation or by consulting a third reviewer. Results: A total of 34 out of 407 studies considered for the review. The overall prevalence of untreated indications, treatment without indication, inadequate dose, over dose, ineffective treatment, drug interactions and adverse drug reactions was found to be 14.96% (95% Confidence Interval [CI]: 11.86-18.05; 25 studies); 8.54% (95% CI: 6.82-10.27; 23studies); 8.94% 95% CI: 7.11-10.78; 23 studies); 9.20% (95% CI: 3.03-15.37; 23 studies); 17.53% (95% CI: 12.92-22.14; 9 studies); 10.58% (95% CI: 8.66-12.50; 24 studies) and 12.68% (95% CI: 10.52-14.83; 28 studies), respectively. Moreover, DRPs were higher among the T2DM patients with CVD than the patients with T2DM alone. The quality of the included studies appeared to be moderate to high. Conclusion: Our findings indicate that DRPs were higher among the T2DM patients with CVD than the patients with T2DM alone. There is a need of multi-disciplinary treatment approach to control the prevalence of DRPs.