Impact of Clinical Pharmacist Intervention and Dapagliflozin Add-On Therapy on Glycemic Control in Type 2 Diabetes

Background: Type 2 diabetes is a major global health issue. Poor glycemic control, often due to non-adherence, increases complications. Pharmacologic intensification and pharmacist-led interventions help optimize diabetes management. Objectives: To assess clinical pharmacist interventions and dapagliflozin effects on glycemic control, safety, and adherence in type 2 diabetes. Methods: A 3-month, three-arm open-label randomized controlled trial (RCT) conducted in Sulaimani city, Iraq, on adults with T2DM (HbA1c 7–10%, n=138) were randomized to dapagliflozin add-on (G1, n=46), clinical pharmacist intervention (G2, n=46; including medication optimization, adherence support, and counselling), or standard therapy (G3, n=46). Primary outcomes were HbA1c, fasting plasma glucose (FPG) changes, and safety; secondary included lipids, blood pressure, and adherence (Modified Hill-Bone scale). Results: Among 125 completers, the median (IQR) difference in the HbA1c % was -0.7(-1.6 to 0.0) for G1, -0.665 (-1.55 to -0.245) for G2, and +0.05 (-0.3 to 0.597) for G3, which was significantly different between G1 and G3 and G2 and G3. The difference in the FPG was -37 (-83 to 1.0) for G1, -14.5 (-38.75 to 6) for G2, and -1.5 (-11.75 to 30.75) for G3. The difference is significant between G1 and G3, and G2 and G3. Medication adherence improved significantly only in G2 (high adherence: 80% to 95%, p=0.043). Adverse events were low in all groups (hypoglycemia: 4.5–7.3%), while UTIs were 7.3% in G1 only. Conclusions: Clinical pharmacist-led interventions were equally as effective as dapagliflozin for glycemic control but superior in enhancing medication adherence.