{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T12:33:51Z","timestamp":1785155631630,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease requiring effective pharmacological treatment, sustained self-management, and patient education. Pharmacists are increasingly recognized as key contributors to diabetes care; however, their role remains underutilized in Bulgaria. This study aimed to assess self-management behaviors, medication adherence, patient awareness, and the perceived role of pharmacists among patients with T2DM in Bulgarian primary care. Methods: A cross-sectional observational study was conducted among 105 patients with T2DM using an anonymous questionnaire based on the Diabetes Self-Management Questionnaire and supplementary items adapted to the local healthcare context. Data were analyzed using descriptive statistics and non-parametric tests to explore associations between demographic characteristics, treatment patterns, self-management behaviors, and educational needs. Results: Most patients were treated with oral antidiabetic therapy (90.0%), predominantly metformin-based regimens (64.0%). Adherence to prescribed pharmacological treatment was high (93.0%), while adherence to dietary recommendations (70.0%), regular physical activity (60.0%), and blood glucose self-monitoring (63.0%) was less consistent. Although 92.0% of participants reported good or excellent disease awareness, 41.0% expressed a need for additional education, particularly regarding confidence in managing hypoglycemia and the use of digital monitoring tools. More than half of respondents (54.0%) had received diabetes-related information from a pharmacist; however, only 38.0% expressed willingness to participate in pharmacist-led education, while 34.0% were undecided. Female sex was associated with a higher prevalence of comorbidities (p = 0.010), while increasing age was associated with reduced metformin use (p = 0.004). Conclusions: Despite good pharmacological adherence and self-reported awareness, gaps remain in lifestyle-related self-management and patient education. The findings support an expanded role for pharmacists in diabetes care, particularly through structured educational and counseling interventions to enhance self-management and complement physician-led treatment.<\/jats:p>","DOI":"10.3390\/pharmacy14010035","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:05:46Z","timestamp":1770897946000},"page":"35","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Self-Management, Adherence, and the Role of Pharmaceutical Care in Patients with T2DM in Primary Practice: A Cross-Sectional Survey in Bulgaria"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6606-5048","authenticated-orcid":false,"given":"Petya","family":"Milushewa","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4502-8407","authenticated-orcid":false,"given":"Nataliya","family":"Chenesheva","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-1054","authenticated-orcid":false,"given":"Valentina","family":"Petkova","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2023). Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes\u20142023. Diabetes Care, 46, S19\u2013S40.","DOI":"10.2337\/dc23-S002"},{"key":"ref_2","unstructured":"International Diabetes Federation (2025). IDF Diabetes Atlas, International Diabetes Federation. [11th ed.]. Available online: https:\/\/diabetesatlas.org."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/S0140-6736(05)67402-8","article-title":"The metabolic syndrome\u2014A new worldwide definition","volume":"366","author":"Alberti","year":"2005","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/j.1464-5491.2006.01858.x","article-title":"Metabolic syndrome\u2014A new world-wide definition. A Consensus Statement from the International Diabetes Federation","volume":"23","author":"Alberti","year":"2006","journal-title":"Diabet. Med. A J. Br. Diabet. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/S0140-6736(05)66378-7","article-title":"The metabolic syndrome","volume":"365","author":"Eckel","year":"2005","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.2337\/dci22-0034","article-title":"Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"45","author":"Davies","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(18)32590-X","article-title":"SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: A systematic review and meta-analysis of cardiovascular outcome trials","volume":"393","author":"Zelniker","year":"2019","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.2147\/PPA.S106821","article-title":"Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors","volume":"10","author":"Polonsky","year":"2016","journal-title":"Patient Prefer. Adherence"},{"key":"ref_9","first-page":"533","article-title":"Opportunities and responsibilities in pharmaceutical care","volume":"47","author":"Hepler","year":"1990","journal-title":"Am. J. Hosp. Pharm."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Coutureau, C., Slimano, F., Mongaret, C., and Kanagaratnam, L. (2022). Impact of Pharmacists-Led Interventions in Primary Care for Adults with Type 2 Diabetes on HbA1c Levels: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19063156"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.2147\/PPA.S530503","article-title":"Effectiveness of Pharmacist-Led Intervention on Medication Adherence in Chronic Diseases: A Systematic Review of Randomized Controlled Trials","volume":"19","author":"Farhana","year":"2025","journal-title":"Patient Prefer. Adherence"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"79","DOI":"10.3897\/pharmacia.66.e36530","article-title":"Evaluation of the current status of the value-added pharmacy services and pharmacists\u2019 attitude in Bulgaria","volume":"66","author":"Balkanski","year":"2019","journal-title":"Pharmacia"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care, 47, S20\u2013S42.","DOI":"10.2337\/dc24-S002"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.2337\/dc10-2361","article-title":"Use of metformin in the setting of mild-to-moderate renal insufficiency","volume":"34","author":"Lipska","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/2251-6581-12-14","article-title":"Role of self-care in management of diabetes mellitus","volume":"12","author":"Shrivastava","year":"2013","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.2337\/dci20-0023","article-title":"Diabetes Self-management Education and Support in Adults with Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association","volume":"43","author":"Powers","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_17","first-page":"9408316","article-title":"Association of Demographic Variables with the Awareness of Type 2 Diabetes Mellitus Patients (T2DM) among the Northwest Population in Saudi Arabia","volume":"2020","author":"Albalawi","year":"2020","journal-title":"J. Diabetes Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Celik, S., Olgun, N., Yilmaz, F.T., Anataca, G., Ozsoy, I., Ciftci, N., Aykiz, E.F., Yasa, S., Karakiraz, E., and Ulker, Y. (2022). Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): A multi-center study. BMC Nurs., 21.","DOI":"10.1186\/s12912-022-01001-1"},{"key":"ref_19","unstructured":"International Diabetes Federation (2021). IDF Diabetes Atlas, IDF. [10th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1001\/jama.288.4.475","article-title":"Association of health literacy with diabetes outcomes","volume":"288","author":"Schillinger","year":"2002","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0738-3991(03)00016-8","article-title":"Diabetes patient education: A meta-analysis and meta-regression","volume":"52","author":"Ellis","year":"2004","journal-title":"Patient Educ. Couns."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/MLR.0b013e3181e57962","article-title":"US pharmacists\u2019 effect as team members on patient care: Systematic review and meta-analyses","volume":"48","author":"Spivey","year":"2010","journal-title":"Med. Care"},{"key":"ref_23","first-page":"493","article-title":"Pharmacist Interventions in the Management of Type 2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials","volume":"22","author":"Pousinho","year":"2016","journal-title":"J. Manag. Care Spec Pharm."},{"key":"ref_24","first-page":"2000","article-title":"Clinical pharmacists\u2019 interventions in the management of type 2 diabetes mellitus: A systematic review","volume":"18","author":"Pousinho","year":"2020","journal-title":"Pharm. Pract."},{"key":"ref_25","unstructured":"International Pharmaceutical Federation (FIP) (2017). The Role of Pharmacists in Diabetes Care, International Pharmaceutical Federation."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/1\/35\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T13:06:53Z","timestamp":1770901613000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/1\/35"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["pharmacy14010035"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy14010035","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]}}}