A panel of 26 clinicians reached consensus on 42 recommendations for sick day medication guidance, including temporarily stopping RAS inhibitors, diuretics, NSAIDs, SGLT2 inhibitors, and metformin.
A multidisciplinary expert panel reached consensus on 42 recommendations for sick day medication guidance, including holding RAS inhibitors, diuretics, and SGLT2 inhibitors during volume depletion.
RATIONALE 6 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 related to scenarios and strategies for patient self-management (including frequent glucose monitoring, checking ketones, fluid intake, and consumption of food to prevent hypoglycemia). There was consensus that renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, sodium/glucose cotransporter 2 inhibitors, and metformin should be temporarily stopped. Participants recommended that insulin, sulfonylureas, and meglitinides be held only if blood glucose was low and that basal and bolus insulin be increased by 10%-20% if blood glucose was elevated. There was consensus on 6 recommendations related to the resumption of medications within 24-48 hours of the resolution of symptoms and the presence of normal patterns of eating and drinking. LIMITATIONS: Participants were from high-income countries, predominantly Canada. Findings may not be generalizable to implementation in other settings. CONCLUSIONS: A multidisciplinary panel of clinicians reached a consensus on recommendations for SDMG in the presence of signs and symptoms of volume depletion, as well as self-management strategies and medication instructions in this setting. These recommendations may inform the design of future trials of SDMG strategies.
Watson et al. (Mon,) conducted a other in Diabetes, kidney, or cardiovascular disease (n=26). Modified Delphi process for sick day medication guidance was evaluated on Consensus (>75% agreement) on recommendations for sick day medication guidance. A panel of 26 clinicians reached consensus on 42 recommendations for sick day medication guidance, including temporarily stopping RAS inhibitors, diuretics, NSAIDs, SGLT2 inhibitors, and metformin.