老年人停用抗高血糖药物：基于证据的临床实践指南。
Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline.
机构信息
Scientist at the Bruyère Research Institute and C.T. Lamont Primary Health Care Research Centre, Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, and Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario.
Research Coordinator at the Bruyère Research Institute.
出版信息
Can Fam Physician. 2017 Nov;63(11):832-843.
OBJECTIVE
To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults.
METHODS
We focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest. We used a rigorous process, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, for guideline development. We conducted a systematic review to assess evidence for the benefits and harms of deprescribing antihyperglycemic agents. We performed a review of reviews of the harms of continued antihyperglycemic medication use, and narrative syntheses of patient preferences and resource implications. We used these syntheses and GRADE quality-of-evidence ratings to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. A decision-support algorithm was developed to accompany the guideline.
RECOMMENDATIONS
We recommend deprescribing antihyperglycemic medications known to contribute to hypoglycemia in older adults at risk or in situations where antihyperglycemic medications might be causing other adverse effects, and individualizing targets and deprescribing accordingly for those who are frail, have dementia, or have a limited life expectancy.
CONCLUSION
This guideline provides practical recommendations for making decisions about deprescribing antihyperglycemic agents. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.
目的
制定循证指南，帮助临床医生决策何时以及如何安全地逐渐减少、停止或转换老年人的抗高血糖药物。
方法
我们专注于现有最高级别的证据，并在指南制定、审查和认可过程中寻求初级保健专业人员的意见。共有 7 名临床医生（2 名家庭医生、3 名药剂师、1 名执业护士和 1 名内分泌学家）和 1 名方法学家组成了整个团队；成员披露了利益冲突。我们使用了严格的流程，包括 GRADE（推荐评估、制定和评估分级）方法，用于指南制定。我们进行了系统评价，以评估减少抗高血糖药物的益处和危害的证据。我们对继续使用抗高血糖药物的危害进行了综述评价，并对患者偏好和资源影响进行了叙述性综合分析。我们使用这些综合分析和 GRADE 证据质量评级来生成建议。团队通过共识对指南内容和建议措辞进行了细化，并综合了临床注意事项，以解决一线临床医生的常见问题。该指南草案分发给临床医生和利益相关者进行审查，并在每个阶段进行修订。还制定了决策支持算法来伴随该指南。
建议
我们建议减少已知会导致低血糖风险或抗高血糖药物可能引起其他不良反应的抗高血糖药物，对于身体虚弱、患有痴呆症或预期寿命有限的患者，应根据具体情况个体化目标并减少用药。
结论
本指南为决定减少抗高血糖药物提供了实用建议。建议旨在协助而不是决定与患者共同决策。
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