Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular...

Area of Science:

• Clinical Medicine
• Pharmacology
• Nephrology

Background:

• Sick day medication guidance (SDMG) is crucial for managing acute illnesses, preventing complications like hypotension, acute kidney injury (AKI), and hypoglycemia.
• Developing evidence-based SDMG recommendations is essential for clinical practice and future research.

Approach:

• A modified Delphi process was employed with an international panel of 26 clinicians from diverse disciplines and countries.
• Three rounds of virtual meetings facilitated the development, refinement, and voting on recommendations, ensuring expert consensus (>75% agreement).
• Quantitative data (agreement percentages) and qualitative content analysis were used to summarize findings and capture discussion context.

Key Points:

• Consensus was reached on 42 recommendations, including 5 on volume depletion signs, 6 on urgent care triggers, and 14 on self-management strategies (e.g., glucose monitoring, fluid intake).
• Specific guidance was established for withholding renin-angiotensin system inhibitors, diuretics, NSAIDs, SGLT2 inhibitors, and metformin.
• Recommendations for insulin and other glucose-lowering agents were refined based on blood glucose levels, with clear instructions for resumption of medications post-illness.

Conclusions:

• A multidisciplinary expert panel established consensus on comprehensive SDMG recommendations.
• These recommendations provide a framework for patient self-management and medication adjustments during acute illnesses.
• The findings are intended to inform the design of future intervention studies on SDMG strategies.