What a SMART pharmacist can discover in only one day: A public health initiative focused on diabetes in North Macedonia

Background/Objectives: Pharmacists’ roles are shifting from dispensing medications to managing chronic diseases and prevention. Diabetes is a growing public health issue requiring early detection and management, where pharmacists can play a key role. The SMART Pharmacist Program promotes continuing education and expanded care, and a nationwide blood sugar screening campaign in North Macedonia was conducted to evaluate the impact of pharmacists in detecting undiagnosed diabetes and supporting glycemic control. Methods: This descriptive observational cross-sectional study was conducted mainly on 14 November 2024, in 98 community pharmacies across 14 cities. Participants over 18 years old were recruited via voluntary sampling. A total of 998 measurements were performed on the campaign day, with additional screening extending to 24 January 2025, totaling 1085 participants. Blood glucose was measured by finger prick testing and classified according to national and NICE guidelines. A structured questionnaire collected demographic, medical, and lifestyle data. Results: Among 1085 participants (65.1% female, mean age 57.6 ± 14.5 years), 258 (23.8%) had diagnosed diabetes, mostly Type 2 (226; 20.8%), while 827 (76.2%) were undiagnosed. Males had 1.7 times higher odds of diabetes. Diabetes prevalence correlated with physical inactivity, higher BMI, smoking, and chronic diseases. Among the undiagnosed, 17.8% were prediabetic and 4.3% diabetic. Of diagnosed patients, 57% had well-controlled and 42% poorly controlled diabetes. Metformin-based therapies were most common for Type 2 diabetes. Conclusions: Community pharmacists can effectively support early detection of diabetes and identify patients with suboptimal glycemic control, enhancing diabetes management in the community.