5 th International Current Breakthrough in Pharmacy (ICB-Pharma) 2024, Indonesia | 18 Review Article THE INFLUENCE OF MEDICATION THERAPY MANAGEMENT (MTM) ON CLINICAL OUTCOMES AND TREATMENT COMPLIANCE IN DIABETES MELLITUS PATIENTS: A SYSTEMATIC REVIEW MIKA TRI KUMALA SWANDARI 1,2 , HIDAYAH KARUNIAWATI 1* , ZAKKY CHOLISOH 1 1 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Indonesia. 2 Faculty of Pharmacy, Sains dan Teknologi, Universitas Al-Irsyad Cilacap, Indonesia * Corresponding author: Hidayah Karuniawati; * Email: hk170@ums.ac.id Received: 06 May 2024, Revised and Accepted: 30 Aug 2024 ABSTRACT This systematic review aims to determine the effect of MTM carried out by pharmacists on achieving medication adherence and clinical outcomes in diabetes mellitus patients. The journal search method was taken from PUBMED, Scopus, and Google Scholar using the keywords "diabetes mellitus", "DM", "medication therapy management", "MTM", "clinical outcome", "clinical results", "adherence", and " treatment compliance”. The research identified came from Indonesia, the United States, Ethiopia, Brazil, New Zealand, Japan, Lebanon, and Malaysia. Out of the 169 studies identified, twenty- five met the inclusion and exclusion criteria, consisting of 5 RCTs, seven cohorts, and 13 quasi-experiments. MTM improves compliance and clinical outcomes of DM patients. Compliance increased from 80.5% to 87.5% (p<0.05). The average HbA1c value decreased from 10.5 to 8.2 (p<0.05), the average systolic blood pressure (SBP) decreased from 142.7 mmHg to 135.6 mmHg (p<0.05), mean diastolic blood pressure (DBP) decreased from 89.9 mmHg to 83.6 mmHg (p<0.05), and mean fasting plasma glucose (FPG) decreased from 218.5 mg/dl to 142.4 mg/dl (p<0.05). Overall, this study shows that pharmacist-provided MTM services can improve clinical outcomes and medication adherence in patients with diabetes. Keywords: Pharmacist, Medication therapy management, Clinical outcomes, Medication adherence © 2024 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/) DOI: https://dx.doi.org/10.22159/ijap.2024.v16s5.52471 Journal homepage: https://innovareacademics.in/journals/index.php/ijap INTRODUCTION Diabetes is a condition where insulin production is disrupted, which causes sugar to build up in the blood and has the potential for heart attacks, high blood pressure, kidney failure, and death [1]. Diabetes also causes ocular complications that remain a prominent factor in causing blindness [2]. Diabetes is a chronic disease that is a significant health concern with long-lasting impacts on clinical results and patient economics and requires meticulous management [3]. The International Diabetes Federation (IDF) data indicates that the direct expenses for diabetes treatment amount to about 727 billion United States Dollars (USD) annually, accounting for around 12% of worldwide health funding [4]. In 2014, around 422 million adults worldwide had diabetes mellitus (DM), with a prevalence of 8.5% in the adult population. This number is projected to rise to 641.8 million by 2040 [3]. Therefore, serious treatment, both prevention and effective and efficient management, is needed [4]. Numerous governmental and private groups have dedicated significant time, effort, and resources to address this global issue through treatment, prevention, and education [5]. There are numerous methods available for treating and managing diabetes mellitus. For example, niosomes, human embryonic stem cells (hESC), and human Induced pluripotent stem cells (hiPSC). Niosomes as drug delivery systems have improved in the treatment of diabetes because of the improvement in the bioavailability of antidiabetic drugs [6]. Also, with the advancement of diabetes mellitus treatment, hESC and hiPSC have become recognized as the potential future of diabetes treatment because the treatment could yield significant outcomes within a period of one to two months [7]. With all of the available treatments for diabetes mellitus, Medication Therapy Management (MTM) emerges as a crucial approach. Medication Therapy Management (MTM) is pharmaceutical management through a patient-centric and comprehensive approach to optimize drug use, reduce the risk of side effects, and increase treatment compliance so that clinical outcome targets can be achieved [8]. The Medication Therapy Management (MTM) service model in pharmaceutical practice consists of five elements: Medication Therapy Review (MTR), Personal Medication Record (PMR), Medication-related Action Plan (MAP), Intervention and Referral, and Documentation and Follow-up. MTR is a systematic process for gathering patient-specific information, assessing therapy, identifying actual and potential drug- related problems, compiling a prioritized list of problems, and creating a plan to resolve them. PMR is a comprehensive record of independent patient therapy, such as buying medicine at a pharmacy without a recommendation from a doctor or consuming traditional medicine [9, 10]. MAP is a document that contains a list of actions that patients can take to determine the progress of therapy as self-management. Intervention and/or referral is the stage where pharmacists provide consultation and intervention services to overcome drug-related problems, as well as refer patients to doctors or other health professionals if needed. Documentation and Follow-up is recording and reviewing all activities or actions towards patients [9, 10]. MTM services focus on implementing preventative health tactics to enhance therapy outcomes. Pharmacists are knowledgeable in medication and play a crucial role in assisting patients in maximizing their treatment through MTM services. Pharmacists are trained to assess and determine drug suitability so that clinical outcomes are achieved, as well as reducing barriers to non-adherence. This program may be useful for patients with chronic diseases such as diabetes [3]. This systematic review aims to assess the impact of pharmacist-delivered MTM interventions on clinical outcomes and medication adherence in diabetes mellitus patients. This systematic review has new information because it combines the benefits of MTM on clinical outcomes and treatment adherence in patients with diabetes. Clinical outcomes are more varied by adding fasting plasma glucose (FPG) as a measure of MTM success in diabetic patients, in addition to hemoglobin A1c (HbA1c) and general clinical outcomes such as blood pressure (BP), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), triglycerides (TD), low-density lipoprotein (LDL), and high- density lipoprotein (HDL). Methods Articles search strategy This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The literature search strategy is systematic, focused, and carried out by researchers to identify relevant articles. The search technique included a combination of "medical subject headings" (MeSH), title, and abstract keywords. The search approach involves utilizing three International Journal of Applied Pharmaceutics ISSN- 0975-7058 Vol 16, Special Issue 5, 2024