Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Institut de Pharmacie, CHU Lille, F-59000 Lille, France.
Int J Med Inform. 2024 Nov;191:105581. doi: 10.1016/j.ijmedinf.2024.105581. Epub 2024 Jul 30.
The management of chronic diabetes mellitus and its complications demands customized glycaemia control strategies. Polypharmacy is prevalent among people with diabetes and comorbidities, which increases the risk of adverse drug reactions. Clinical decision support systems (CDSSs) may constitute an innovative solution to these problems. The aim of our study was to conduct a systematic review assessing the value of CDSSs for the management of antidiabetic drugs (AD).
We systematically searched the scientific literature published between January 2010 and October 2023. The retrieved studies were categorized as non-specific or AD-specific. The studies' quality was assessed using the Mixed Methods Appraisal Tool. The review's results were reported in accordance with the PRISMA guidelines.
Twenty studies met our inclusion criteria. The majority of AD-specific studies were conducted more recently (2020-2023) compared to non-specific studies (2010-2015). This trend hints at growing interest in more specialized CDSSs tailored for prescriptions of ADs. The nine AD-specific studies focused on metformin and insulin and demonstrated positive impacts of the CDSSs on different outcomes, including the reduction in the proportion of inappropriate prescriptions of ADs and in hypoglycaemia events. The 11 nonspecific studies showed similar trends for metformin and insulin prescriptions, although the CDSSs' impacts were not significant. There was a predominance of metformin and insulin in the studied CDSSs and a lack of studies on ADs such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.
The limited number of studies, especially randomized clinical trials, interested in evaluating the application of CDSS in the management of ADs underscores the need for further investigations. Our findings suggest the potential benefit of applying CDSSs to the prescription of ADs particularly in primary care settings and when targeting clinical pharmacists. Finally, establishing core outcome sets is crucial for ensuring consistent and standardized evaluation of these CDSSs.
慢性糖尿病及其并发症的管理需要定制的血糖控制策略。患有糖尿病和合并症的人普遍需要使用多种药物，这增加了药物不良反应的风险。临床决策支持系统（CDSS）可能是解决这些问题的创新方案。我们的研究目的是对评估 CDSS 在抗糖尿病药物（AD）管理中的价值进行系统评价。
我们系统地搜索了 2010 年 1 月至 2023 年 10 月期间发表的科学文献。检索到的研究分为非特异性或 AD 特异性。使用混合方法评估工具评估研究质量。该综述的结果按照 PRISMA 指南进行报告。
符合纳入标准的研究有 20 项。大多数 AD 特异性研究是在非特异性研究（2010-2015 年）之后的最近几年（2020-2023 年）进行的。这一趋势表明，人们越来越关注为 AD 处方定制更专业的 CDSS。9 项 AD 特异性研究专注于二甲双胍和胰岛素，结果表明 CDSS 对不同结局的积极影响，包括减少 AD 不适当处方的比例和低血糖事件。11 项非特异性研究显示，二甲双胍和胰岛素的处方也有类似的趋势，尽管 CDSS 的影响并不显著。在研究的 CDSS 中，二甲双胍和胰岛素占主导地位，而对 SGLT-2 抑制剂和 GLP-1 受体激动剂等 AD 的研究较少。
对评估 CDSS 在 AD 管理中应用的研究数量有限，特别是随机临床试验，突显了进一步研究的必要性。我们的研究结果表明，在初级保健环境中以及针对临床药师时，应用 CDSS 管理 AD 处方具有潜在益处。最后，建立核心结局集对于确保对这些 CDSS 的一致和标准化评估至关重要。
