The Science of Diabetes Self-Management and Care 2025, Vol. 51(5) 462 –475 © The Author(s) 2025 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/26350106251361368 journals.sagepub.com/home/tde
Abstract
Background: Pharmacist-led multidisciplinary care may enhance diabetes self-management, yet evidence from Taiwan is limited. This study evaluates the impact of such interventions on health literacy, medication adherence, and clinical outcomes in patients with type 2 diabetes.
Methods: A quasi-experimental pretest-posttest study was conducted at Taipei City Hospital (April to December 2021) with 70 adults allocated into a pharmacist-led care group or standard care group. The intervention included medication management, diabetes education, and structured follow-ups. Generalized estimating equations analyzed changes in health literacy, medication adherence, weight, low-density lipoprotein cholesterol (LDL-C), A1C, fasting glucose, and total cholesterol (TC).
Results: The intervention group achieved a 21.1% increase in health literacy and a 20.4% improvement in medication adherence (P < .01). Significant reductions were observed in weight (B = –0.16, P < .01) and LDL-C (B = –12.83, P = .02). Differences in A1C, fasting glucose, and TC were not statistically significant, although time effects suggested overall improvement.
Conclusions: Pharmacist-led care significantly improved health literacy, adherence, and some clinical outcomes in patients with type 2 diabetes. These findings highlight the value of integrating pharmacists into multidisciplinary teams to enhance chronic disease management.
Diabetes mellitus is a chronic, lifelong condition requiring continuous management to prevent severe complications and maintain quality of life. Globally, diabetes imposes a substantial economic burden, with annual costs per patient ranging from USD $87 to over USD $9500, depending on health care systems and geographic regions.1 In Taiwan, diabetes consistently ranks among the top 6 leading causes of death, imposing a substantial economic burden on both individuals and the health care system. Patients with diabetes incur health care costs approximately 4.3 times higher than those of the general population, with 25% to 30% of diabetes-related expenditures allocated to managing complications such as cardiovascular and kidney diseases.2,3 Beyond direct medical expenses, the economic implications extend to workforce productivity losses and amplified societal costs, further straining limited health care resources. These findings highlight the critical need for cost-effective strategies to prevent and manage diabetes, particularly within resource-constrained health care systems.
A national survey4 revealed that 1 in 4 adults in Taiwan is in a prediabetic state, with 66% of this group exhibiting excessive waist circumferences (≥90 cm for men and ≥80 cm for women) and 65% classified as overweight or obese.5 Furthermore, nearly half (44.7%) of adults ages 20 to 79 with diabetes remain undiagnosed globally, underscoring the critical need for early identification and intervention.6 These alarming statistics highlight the urgency of developing effective strategies tailored to Taiwan’s health care system, bridging gaps between global recommendations and local implementation.
Health literacy, defined as the ability to acquire, understand, and apply health information, is integral to effective diabetes self-management.7 Research consistently links higher health literacy with improved glycemic control and self-care behaviors, yet few studies in Taiwan have examined the pharmacist’s role in advancing these outcomes. A meta-analysis of 15 randomized controlled trials showed that interventions targeting health literacy significantly enhanced self-management and glycemic outcomes in patients with type 2 diabetes.8 However, the application of such findings to Taiwan remains limited, especially regarding how pharmacists can act as key facilitators of health literacy.
Medication adherence is equally pivotal in diabetes care because poor adherence undermines therapeutic efficacy and increases the risk of complications.9 Pharmacist-led educational interventions have demonstrated significant improvements in adherence and clinical outcomes across various studies.10,11 Despite this, pharmacists in Taiwan currently play a relatively limited role in diabetes patient education and medication management, with their primary responsibilities centered around dispensing medications and providing brief medication counseling upon patient inquiry. This reactive approach contrasts with international trends where pharmacists are actively integrated into diabetes care teams, contributing to structured patient education, medication therapy management, and ongoing follow-up. Addressing this gap is essential for improving patient outcomes and fully leveraging pharmacists’ professional expertise in chronic disease management.
The importance of multidisciplinary approaches in diabetes care has been highlighted through the adoption of the 2022 National Standards for Diabetes Self-Management Education and Support (DSMES).4 DSMES emphasizes that diabetes care and education specialists should include diverse health care professionals—physicians, nurses, dietitians, and pharmacists—collaborating to provide comprehensive patient-centered care. DSMES also underscores the need for culturally tailored education that supports patients’ self-care decisions and fosters sustainable behavior changes. However, in Taiwan, DSMES is not yet fully implemented, and pharmacists’ contributions to diabetes self-management education remain underdeveloped. Incorporating DSMES principles into pharmacist-led interventions could enhance the effectiveness and consistency of diabetes education programs in Taiwan, especially for patients with limited health literacy or complex medication regimens.
Pharmaceutical care, which emphasizes pharmacists’ active participation in managing medication therapy, has proven effective in enhancing outcomes. A meta-analysis of 56 studies confirmed that integrating pharmacists into multidisciplinary care teams improves patient outcomes while reducing health care costs.12 Moreover, a randomized controlled trial in Vietnam found that pharmacist consultations significantly increased disease knowledge and adherence compared to standard care alone.13 These findings illustrate the potential for pharmacists to play a transformative role in diabetes care, especially in settings where multidisciplinary team models are evolving. However, Taiwan has yet to fully embrace this paradigm, with pharmacists often overshadowed by nurses and dietitians in diabetes care teams. Addressing this gap is essential to improving care quality and efficiency.
This study aims to evaluate the impact of pharmacist-led multidisciplinary care on self-care skills, health literacy, medication adherence, and clinical outcomes among patients diagnosed with type 2 diabetes. By integrating principles from the DSMES framework and tailoring educational content to the cultural context of Taiwan, the study seeks to demonstrate how pharmacist-driven interventions can enhance patient engagement, improve adherence, and optimize clinical outcomes. The findings will contribute to the evidence base supporting expanded pharmacist roles in chronic disease management and provide practical insights for implementing pharmacist-led educational programs in Taiwan’s health care system.
This study employed a quasi-experimental pretest-posttest design with a nonrandomized control group, conducted at a regional teaching hospital in Taipei between April and December 2021. This design balanced the need for clinical feasibility with ensuring scientific rigor in evaluating the effects of pharmacist-led interventions on diabetes self-management outcomes. Baseline data were collected before the intervention (pretest), and outcome data were collected 6 months later (posttest).
Participants and Recruitment
Participants were recruited using convenience sampling from the hospital’s outpatient diabetes clinic. Eligible participants were adults ages 18 years or older with a diagnosis of type 2 diabetes who were capable of providing informed consent. Exclusion criteria included pregnancy, severe cognitive impairment, concurrent participation in other clinical trials, or requiring immunosuppressive therapy.
Following eligibility screening and informed consent, participants completed baseline assessments to collect demographic, clinical, and self-reported data. Participants were then assigned to either the pharmacist-led intervention group or the standard care control group using a lottery-based method to balance group sizes. This allocation method was employed to ensure operational feasibility within the hospital’s routine care processes.
Ethical Considerations
Ethical approval for this study was obtained from the Institutional Review Board of the study hospital (Approval No. TCHIRB-11002018-E ). Written informed consent was obtained from all participants before data collection.
The pharmacist-led intervention group received comprehensive pharmaceutical care integrated into the hospital’s multidisciplinary diabetes care model. The pharmacist, a certified diabetes care and education specialist, provided personalized education and medication management following the 2022 National Standards for DSMES framework.
Key components of the intervention included the following.
Individualized education. Topics covered diabetes pathophysiology, self-monitoring of blood glucose, proper medication use, lifestyle modification (diet and exercise), and prevention/management of acute complications.
Pharmaceutical care services. The pharmacist conducted medication reconciliation, adherence assessments, drug interaction screening, and adverse reaction management. Findings were shared with the health care team to ensure coordinated care.
Session delivery. One-on-one educational sessions were provided monthly for 6 months, with each session lasting approximately 30 to 60 minutes. Sessions were held in a dedicated diabetes education room to ensure privacy and maximize patient engagement.
Tailored counseling. Educational materials were culturally adapted, incorporating visual aids, teach-back techniques, and simplified language to align with participants’ health literacy levels.
The control group received standard multidisciplinary care, which involved regular outpatient consultations with physicians, nurses, and dietitians. Pharmacists’ roles were limited to dispensing medications and responding to patient-initiated inquiries, without proactive educational or medication management services.
Data collection occurred at 2 time points: baseline (pretest) and 6 months after enrollment (posttest). Data were gathered through structured questionnaires, patient interviews, and electronic health record reviews. Trained research staff collected all data following standardized procedures to ensure consistency and accuracy. The following data were collected:
Demographic and clinical characteristics: age, gender, educational level, duration of diabetes, number of prescribed medications, and comorbidities.
Primary outcomes (self-reported): health literacy (measured by the Short-Form Mandarin Health Literacy Scale [s-MHLS]) and medication adherence (measured by the Morisky Medication Adherence Scale-8 [MMAS-8]).
Secondary outcomes (clinical indicators): body weight, A1C, fasting plasma glucose (FPG), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC).
Safety outcomes: incidence of adverse drug reactions and occurrence of medication-related problems, documented through patient self-reports and pharmacist assessments.
Health literacy. The s-MHLS is an 11-item instrument validated for Taiwanese populations.14 It evaluates participants’ ability to access, understand, and apply health information, including numeracy skills. Total scores range from 0 to 11, with higher scores indicating better health literacy. The s-MHLS demonstrated strong internal consistency (Cronbach’s α = 0.94) in prior studies and maintained good reliability in this study.
Medication adherence. The 8-item MMAS-8 assessed self-reported medication adherence. It includes 7 yes/no questions and 1 Likert-scale item, yielding a total score between 0 and 8. Higher scores reflect better adherence. The MMAS-8 has been validated in Taiwanese diabetes populations, showing acceptable internal consistency (Cronbach’s α = 0.65) and strong test-retest reliability.15
Clinical indicators. Clinical data, including A1C, FPG, LDL-C, TC, and body weight, were extracted from participants’ medical records at baseline and 6 months. Standardized laboratory protocols were followed for all biochemical analyses.
Safety outcomes. Two safety indicators were evaluated: adverse drug reactions, which were documented if participants reported new or worsened symptoms linked to medications, AND Medication-related problems, which were defined as any issue requiring pharmacist intervention, including potential drug interactions, inappropriate medication use, or participant-reported concerns.
Descriptive statistics summarized baseline characteristics, with means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Between-group differences at baseline were assessed using independent samples t tests for continuous data and chi-square tests for categorical data.
To assess the effectiveness of the intervention, paired samples t tests compared pretest and posttest values within each group, and independent samples t tests compared posttest differences between groups.
To account for within-subject correlations and assess time-by-group interaction effects, generalized estimating equations (GEEs) were employed as the primary analytical method. GEE models included time (pretest/posttest), group (intervention/control), and the Time × Group interaction term. Covariates (age, gender, disease duration) were included to adjust for baseline differences and potential confounders.
Missing data were handled using multiple imputation, generating 20 imputed data sets to enhance robustness. Sensitivity analyses confirmed consistency across imputation scenarios, ensuring reliable interpretation of findings.
All statistical analyses were conducted using SPSS version 22.0 (IBM Corp., Armonk, NY), with statistical significance set at P < .05 (two-tailed).
The baseline characteristics of study participants are presented in Table 1. A total of 70 participants were enrolled, with 35 assigned to the pharmacist-led intervention group and 35 to the standard care control group. The mean age of the intervention group was 61.34 years (SD = 13.07), slightly older than the control group’s mean age of 58.06 years (SD = 14.60), but this difference was not statistically significant (t = 0.99, P = .32).
The duration of diabetes was also slightly longer in the intervention group (M = 6.37 years, SD = 5.07) compared to the control group (M = 4.74 years, SD = 3.94), although this difference did not reach statistical significance (t = 1.50, P = .13). The 2 groups were comparable in terms of the number of specialty visits (P = .14), gender distribution (P = .08), and educational level (P = .42).
Participants in the intervention group were prescribed a significantly higher number of antidiabetic medications (M = 2.43, SD = 0.92) compared to the control group (M = 1.77, SD = 0.94; t = 2.96, P = .01). Similarly, the number of concurrent medications was also significantly higher in the intervention group (M = 6.23, SD = 3.09) than in the control group (M = 4.74, SD = 2.22; t = 2.31, P = .02), indicating a potentially greater disease complexity in the intervention group.
The internal consistency reliability of the s-MHLS and MMAS-8 scales was assessed using Cronbach’s α; results are summarized in Table 2.
In the intervention group, Cronbach’s α for the s-MHLS was 0.84 at pretest and 0.80 at posttest, and in the control group, it improved from 0.81 to 0.92. For the MMAS-8, Cronbach’s α in the intervention group increased from 0.74 to 0.77, and in the control group, it increased from 0.76 to 0.91. These results confirm that both instruments demonstrated acceptable internal consistency and were suitable for evaluating changes in health literacy and medication adherence over time.
The pretest and posttest comparisons for health literacy, medication adherence, and clinical indicators are shown in Table 3.
Health literacy. In the intervention group, health literacy scores significantly improved from a pretest mean of 9.49 (SD = 2.05) to a posttest mean of 10.74 (SD = 0.61; t = 3.61, P < .01). The control group also showed a significant improvement, from 9.71 (SD = 2.08) to 10.51 (SD = 1.60; t = 2.55, P = .01). However, the betweengroup difference at posttest was not statistically significant (t = 0.79, P = .43), indicating that both groups improved over time.
Medication adherence. The intervention group demonstrated a significant increase in medication adherence scores, improving from 5.40 (SD = 1.27) to 6.50 (SD = 1.06; t = 4.62, P < .01). Similarly, the control group improved from 5.29 (SD = 1.53) to 6.19 (SD = 1.53; t = 3.34, P < .01). The between-group difference at posttest was not statistically significant (t = 0.97, P = .33), suggesting that both groups benefited from general diabetes care.
Clinical indicators Weight. Neither group showed a statistically significant change in body weight over time (P > .05), with no significant between-group differences at posttest (P = .19).
A1C. Both groups experienced slight reductions in A1C, but the changes were not statistically significant within groups (P > .05) or between groups at posttest (P = .54).
FPG. Modest reductions in FPG were observed in both groups, but these changes were not statistically significant (P > .05).
LDL-C. The intervention group demonstrated a significant reduction in LDL-C, from 94.29 mg/dL (SD = 22.92) to 84.86 mg/dL (SD = 14.76; t = –2.65, P = .01), whereas the control group showed a nonsignificant increase (P = .45). The between-group difference in LDL-C reduction favored the intervention group.
Total cholesterol. Changes in total cholesterol were not statistically significant within or between groups (P > .05).
The GEE analysis was conducted to evaluate longitudinal changes in all outcome variables, accounting for withinsubject correlations and adjusting for baseline covariates (age, gender, and disease duration). The results are summarized in Table 4.
Key findings
Health literacy. A significant time effect was observed (B = 0.80, P = .015), indicating that both groups improved over time. However, the time-by-group interaction was not significant (B = 0.46, P = .327), indicating no differential effect between the 2 groups.
Medication adherence. Similar to health literacy, a significant time effect was found (B = 0.90, P = .006), with no significant time-by-group interaction (P = .675).
Weight. A significant time-by-group interaction (B = 0.16, P < .001) indicated greater weight reduction in the intervention group compared to the control group.
A1C. The time-by-group interaction approached significance (B = –0.38, P = .066), suggesting a possible trend toward greater A1C reduction in the intervention group.
LDL-C. A significant time-by-group interaction (B = –12.83, P = .023) demonstrated greater LDL-C reduction in the intervention group.
Adverse drug reactions. No significant time or interaction effects were observed (P > .05).
Medication-related problems. A significant time-by-group interaction (OR = 0.02, P < .001) indicated a substantial reduction in medication-related problems in the intervention group compared to the control group.
In summary, the pharmacist-led intervention significantly improved health literacy, medication adherence, and LDL-C levels over the 6-month period. The intervention also led to a significant reduction in medication-related problems. Although improvements in A1C were not statistically significant, the trend favored the intervention group. These findings highlight the potential value of pharmacist-driven care models in enhancing diabetes management outcomes within multidisciplinary care settings.
This quasi-experimental study evaluated the impact of pharmacist-led multidisciplinary care, guided by the principles of the 2022 National Standards for DSMES, on health literacy, medication adherence, and clinical outcomes among patients with type 2 diabetes in Taiwan. Findings revealed significant improvements in health literacy, medication adherence, LDL-C levels, and medication-related problem resolution in the intervention group. However, the impact on A1C and fasting glucose levels was more modest, with no statistically significant between-group differences. These results provide valuable insights into the evolving role of pharmacists within Taiwan’s multidisciplinary diabetes care model, particularly in enhancing patient self-management capacity.
This study demonstrated that pharmacist-led interventions significantly improved health literacy and medication adherence among patients with type 2 diabetes. These findings are consistent with previous studies showing that health literacy plays a crucial role in enhancing diabetes self-management capabilities, medication adherence, and ultimately, glycemic control.7,16 Pharmacists are uniquely positioned to assess patients’ health literacy levels and tailor education using simplified language, teach-back techniques, and visual aids,17 which was an integral part of the intervention in this study.
Both groups demonstrated improvements in health literacy and adherence over time, indicating that even standard multidisciplinary care—including physicians, nurses, and dietitians—contributes to enhanced selfmanagement. However, the pharmacist-led group achieved greater gains, underscoring the added value of pharmacists’ focused attention on medication counseling and literacy enhancement. This aligns with international research demonstrating that pharmacist-led programs improve medication adherence and self-care behaviors through individualized education and structured follow-up.8,11
These findings further support the DSMES framework, which encourages the inclusion of pharmacists in delivering ongoing diabetes self-management education. DSMES emphasizes that multidisciplinary teams should collaboratively enhance patients’ health literacy, self-management confidence, and adherence to prescribed therapies.4 However, in Taiwan, pharmacists’ roles in diabetes education remain largely reactive—limited to dispensing and answering patient-initiated questions—highlighting the importance of expanding pharmacists’ proactive involvement in chronic disease management.18
The pharmacist-led intervention significantly reduced LDL-C levels, a finding consistent with meta-analyses showing pharmacists’ effectiveness in optimizing lipid management through medication review, adherence monitoring, and patient counseling.12 This improvement may stem from pharmacists’ comprehensive medication reviews, timely identification of adherence barriers, and personalized adjustments to patients’ lipid-lowering regimens in collaboration with physicians. Pharmacists’ reinforcement of lifestyle modifications, particularly dietary changes, may also have contributed to lipid improvement.17
However, the intervention’s impact on A1C levels was more modest, with only a nonsignificant trend favoring the intervention group. This is consistent with some international studies, which report that pharmacist-led interventions often show greater effects on intermediate outcomes (eg, adherence, lipids) than on glycemic control itself.11,19 Several factors could explain this result. First, the 6-month intervention period might have been too short to observe significant A1C reductions, especially given the already moderate baseline A1C levels. Second, unmeasured lifestyle factors, such as physical activity and dietary adherence, were not systematically addressed within this pharmacist-driven model, limiting potential synergy between lifestyle and medication interventions.20 Finally, individual differences in disease severity, social support, and psychological stress may have introduced variability in A1C responses.21
One of the most notable findings of this study was the significant reduction in medication-related problems among intervention group participants. This reinforces the well-established role of pharmacists in identifying, preventing, and resolving medication-related issues through structured medication therapy management.22 Pharmacists’ expertise in polypharmacy management, drug interaction screening, and proactive follow-up enabled early detection and resolution of issues that might otherwise have led to poor adherence or adverse clinical outcomes. This finding is particularly relevant in Taiwan, where older adults with diabetes often have multiple comorbidities and complex medication regimens.23
Despite this positive finding, the incidence of adverse drug reactions (ADRs) did not significantly differ between groups. This may reflect the relatively short follow-up period and the relatively low baseline incidence of ADRs among participants. It is also possible that many ADRs were mild and did not require active intervention, thus limiting detectable differences between groups. Future studies with larger sample sizes, longer follow-up periods, and more granular ADR documentation may be needed to fully evaluate pharmacists’ impact on medication safety.24
This study adds to the growing body of evidence supporting the integration of pharmacists into multidisciplinary diabetes care teams in Taiwan. Current practice models often limit pharmacists’ roles to dispensing, leaving significant gaps in patient education, medication adherence support, and proactive problem identification. The positive outcomes observed in this study highlight the potential benefits of expanding pharmacists’ scope of practice to include structured education, medication therapy management, and ongoing follow-up within the DSMES framework.25
To achieve this, policy changes are needed to formally recognize pharmacists’ roles in diabetes care and to develop reimbursement mechanisms for pharmacist-provided education and medication management services.26 Additionally, professional training programs should strengthen pharmacists’ competencies in health literacy assessment, motivational interviewing, and collaborative care planning to better equip them for these expanded roles.27
Several limitations warrant consideration. First, the quasi-experimental design and convenience sampling may limit the generalizability of findings to broader populations. Second, the 6-month intervention period may have been insufficient to capture long-term impacts on glycemic control, complications, or medication safety. Longer follow-up studies are needed to assess sustained effects.20 Third, the study did not comprehensively assess lifestyle factors (diet, physical activity, stress), which are critical determinants of diabetes outcomes. Future pharmacist-led interventions could incorporate these components to achieve a more holistic care model.28 Finally, reliance on selfreported adherence measures introduces potential reporting bias, which could be addressed in future studies through objective pharmacy refill data or electronic adherence monitoring.29
This quasi-experimental study demonstrated that pharmacist-led multidisciplinary care, aligned with the 2022 National Standards for DSMES, contributed to significant improvements in health literacy, medication adherence, and lipid control among patients with type 2 diabetes in Taiwan. The intervention also led to a substantial reduction in medication-related problems, highlighting the critical role of pharmacists in optimizing medication therapy, addressing adherence barriers, and enhancing patient safety. Although the impact on A1C was less pronounced, the overall findings suggest that integrating pharmacists into structured diabetes care programs can effectively strengthen patients’ self-management capabilities and improve selected clinical outcomes.
The study underscores the importance of expanding pharmacists’ roles beyond traditional dispensing functions to include proactive patient education, medication therapy management, and collaborative care planning within multidisciplinary teams. By applying health literacy-centered approaches, including simplified educational materials, teach-back techniques, and culturally tailored counseling, pharmacists can play a pivotal role in improving patient engagement, particularly in populations with low health literacy or complex medication regimens. These findings provide valuable evidence to support policy changes aimed at formally integrating pharmacists into Taiwan’s diabetes care model, with appropriate reimbursement mechanisms to recognize their contributions to patient outcomes.
Despite its promising results, this study is subject to several limitations. The quasi-experimental design and convenience sampling may limit the generalizability of findings, and the 6-month follow-up period may not fully capture the long-term impact of pharmacist-led interventions on glycemic control and diabetes-related complications. Additionally, unmeasured factors, such as dietary patterns, physical activity, and psychological stress, may have influenced clinical outcomes, warranting more comprehensive assessments in future studies. Finally, reliance on self-reported measures for medication adherence and health literacy introduces potential reporting bias, emphasizing the need for future research incorporating objective adherence measures and mixed-method approaches to provide a more holistic understanding of pharmacist-led interventions.
In conclusion, this study adds to the growing body of evidence supporting the expanded role of pharmacists in multidisciplinary diabetes care. By embedding pharmacists into DSMES-informed care teams, health care systems can leverage their medication expertise and patient counseling skills to enhance health literacy, improve medication adherence, and optimize clinical outcomes. These findings offer practical insights to guide health care policy reforms, professional education enhancements, and future research aimed at strengthening pharmacist-led interventions in chronic disease management.
This study was supported by a grant from the Taipei City Hospital (Project No.: TPCH-109-32). The authors would like to thank the Department of Pharmacy and the diabetes education team at the Zhongxing Branch, including the endocrinologists, nurses, and dietitians, for their invaluable assistance. Special thanks are also extended to all the participants who took part in this study, without whom the research would not have been possible.
J.-B. P. conceptualized the study and designed the methodology. Y.-W. G. conducted the investigation, with resources and participant support facilitated by S.-C. W. J.-B. P. also managed the project administration and secured funding for the research. Data curation and validation were performed by W.-H. H., who also conducted the formal analysis and created the visualizations. The first draft of the article was written by J.-B. P. W.-H. H. provided critical revisions and editorial input during the review process. All authors reviewed and approved the final manuscript for submission.
The authors declare that they have no competing interests.
This study was funded by Taipei City Hospital (Project No.: TPCH-109-32).
This study was approved by the Institutional Review Board of Taipei City Hospital (Approval No.: TCHIRB-11002018-E). Participants provided written informed consent and were informed of their rights, including the option to withdraw at any time. Data were anonymized through unique coding and securely stored on a password-protected server accessible only to the research team. No conflicts of interest involving the ethics committee or the institution were identified. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki.
Wei-Hsiang Huang https://orcid.org/0000-0002-5219-7920
The data sets generated and/or analyzed during this study are not publicly available due to the regulations stipulated by the Institutional Review Board of Taipei City Hospital (https://english.tch.gov.taipei/). However, they are available from the first author (Jiunn-Bey Pao, paobey@gmail.com) upon reasonable request.
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From Department of Pharmacy, Taipei City Hospital, Taipei City, Taiwan (Dr Pao, Ms Wu); School of Pharmacy, National Defense Medical University, Taipei City, Taiwan (Dr Pao); Department of Endocrinology & Metabolism, Taipei City Hospital Zhongxing Branch, Taipei City, Taiwan (Dr Guo); Department of Early Childhood Care and Education, University of Kang-Ning, Taipei City, Taiwan (Dr Huang); and Fire Department, New Taipei City Government, New Taipei City, Taiwan (Dr Huang).
Corresponding Author: Wei-Hsiang Huang, Department of Early Childhood Care and Education, University of Kang-Ning, No.137, Lane 75, Sec. 3, Kangning Rd., Neihu District, Taipei City 114311, Taiwan. Email: drddh@g.ukn.edu.tw
