Clinicians provide recommendations for sick day medication guidance
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A group of clinicians provided 46 consensus recommendations for sick day medication guidance for patients with diabetes, kidney or cardiovascular disease, according to data published in the American Journal of Kidney Diseases.
“Sick day medication guidance (SDMG) has been recommended by several organizations to prevent potential complications that can arise when people taking medications for chronic conditions, including diabetes mellitus, kidney, and cardiovascular diseases, experience an acute illness,” Kaitlyn E. Watson, B. Pharm (Hons), PhD, from the University of Alberta, and colleagues wrote. They added, “Before intervention studies can be designed to test the clinical effectiveness of SDMG, additional efforts are needed to establish consensus on the SDMG recommendations for inclusion in future intervention studies.”
In a modified Delphi process, researchers recruited 26 clinician participants from four countries and 10 clinical disciplines through snowball sampling. Participants had expertise relevant to SDMG.
On virtual meetings, participants reviewed literature pertaining to SDMG for patients with diabetes, kidney or cardiovascular disease, completed three rounds of development, refinement and voted on recommendations. Researchers considered consensus on recommendations to be agreement of more than 75% of participants.
Using a qualitative content analysis, researchers summarized the context of the conversation around recommendations and any other considerations. Additionally, researchers summarized quantitative data using counts and percentages.
A total of 42 specific recommendations emerged from the meetings.
According to the study, five were regarding the signs and symptoms accompanying volume depletion that should trigger SDMG; six were regarding signs that should prompt urgent contact with a health care provider including a reduced level of consciousness, severe vomiting, low blood pressure, presence of ketones, tachycardia and fever; and 14 were related to scenarios and strategies for patient self-management, including frequent glucose monitoring, checking ketones, fluid intake and consumption of food to prevent low blood sugars.
Participants agreed that a temporary hold should be placed on renin-angiotensin system inhibitors, diuretics, NSAIDs, sodium-glucose cotransporter-2 inhibitors and metformin. Further, they recommended insulin, sulfonylureas and meglitinides be stopped only if blood glucose was low and that basal and bolus insulin be increased by 10% to 20% if blood glucose was high.
A consensus was formed for six recommendations related to resuming medications within 24 to 48 hours of symptom resolution and the presence of normal eating and drinking patterns.
“In conclusion, we brought together a multidisciplinary international panel of experts and used a systematic process to establish consensus on specific recommendations for signs and symptoms that should trigger SDMG, scenarios and strategies for self-management [vs. health care professional] responses to sick days and guidance on withdrawal, adjustment, and resumption of medications during and after sick days,” Watson and colleagues wrote. “These recommendations can be used to identify information for inclusion in clinician and patient facing resources and inform future studies to investigate the effectiveness of SDMG within clinical care and patient self-management strategies.”
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