Original Title: Protocoles médicaux nationaux et ordonnances associées: antidiabétique

Authors' objectives: The high prevalence of diabetes, its progressive nature and the numerous related complications make the follow-up care complex for this disease. In addition, several new antidiabetic drugs have come onto the market in recent years, offering clinicians many treatment options, each with its own attributes. Given the issues surrounding this chronic condition, multidisciplinary collaboration is an asset for promoting optimal management of affected individuals. In 2016, the INESSS published a national medical protocol (NMP) on adjusting antihyperglycemic agents in type 2 diabetes, together with a national prescription. Given that the validity period for the protocol and prescription expires in October 2019, and in the interest of alignment with the work carried out by the INESSS since their publication, the MSSS’ Direction nationale des soins et services infirmiers (DNSSI) has asked the INESSS, following a prioritization exercise, to update them.

Authors' results and conclusions: RESULTS : The information search identified 1,050 documents, from which 11 CPGs containing recommendations on the pharmacological treatment of type 2 diabetes in adults were selected due to their good methodological quality, based mainly on the rigour with which they were developed. These CPGs are from Canada [Diabetes Canada CPGEC, 2018], the United States [ADA, 2019; Qaseem et al., 2018; Qaseem et al., 2017; VA/DoD EBPWG, 2017], Europe [Cosentino et al., 2019; Davies et al., 2018], Switzerland [Arditi et al., 2018] and the United Kingdom [Hambling et al., 2019; SIGN, 2017]. It should be noted that the eleventh CPG is from the World Health Organization and is intended for countries or settings with limited resources. In accordance with the issues raised by the advisory committee members or by users of the 2016 version of the NMP, the selected CPGs incorporate the principles for medication adjustment and analysis of the risks and benefits associated with the pharmacological treatments in the context of an aging population. In addition to the matter of medication reduction, the other key changes to the NMP include a description of all the classes of available antidiabetic drugs and the addition of guidance to help steer the search and analysis of factors that can influence glycemic control. CONCLUSION: This update of the NMP on the adjustment of antidiabetic medication and the individual adjustment prescription template is based on clinical data and clinical practice recommendations from the literature, which have been enhanced with experiential knowledge from different experts and clinicians, and with contextual knowledge. Upon completion of an analysis involving the triangulation of data from these different sources, the update process allowed to evaluate the relevance of maintaining, removing or modifying the information from the previous version or adding new information, where necessary. The changes made as part of the update process will improve the joint follow-up of patients using antidiabetic therapy and, ultimately, their care experience.

Authors' methods: A systematic review of clinical practice guidelines (CPGs), expert consensus statements, consensus conference reports, guidance documents and other types of publications containing clinical recommendations was conducted in accordance with the INESSS’s standards to update the literature since the previous work was completed. The literature search was limited to items published between April 2016 and April 2019. A manual literature search was also carried out up to September 2019 by consulting the websites of North American regulatory agencies and health technology assessment agencies, as well as those of government agencies and professional societies and associations dealing with the topic of this project. Clinical reference works were consulted as well. Lastly, the bibliographies of the selected publications were examined for other relevant documents.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/antidiabetique.html

Year Published: 2019

URL for published report: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/antidiabetique.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en santé et en services sociaux (INESSS)