Sick Day Medication Guidance for People With Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review

Abstract

Rationale & objective: Sick day medication guidance has been promoted to prevent adverse events for people with chronic conditions. Our aim was to summarize the existing sick day medication guidance and the evidence base for the effectiveness of interventions for implementing this guidance.

Study design: Scoping review of quantitative and qualitative studies.

Setting & population: Sick day medication guidance for people with chronic conditions including diabetes mellitus, kidney diseases, and cardiovascular diseases.

Selection criteria for studies: A search of 6 bibliographic databases (Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and Cochrane Library [via Wiley]) and a comprehensive gray literature search were completed in June 2021.

Data extraction: Intervention and study characteristics were extracted using standardized tools.

Analytical approach: Data were summarized descriptively, and our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews.

Results: The literature search identified 2,308 documents, which were screened against the eligibility criteria, leading to 74 documents that were included. The majority of the identified documents (n = 55) were guidelines or educational resources. Of the 19 primary research studies identified, 10 studies described an intervention, with only 2 examining the effect of sick day medication guidance interventions within clinical care and no studies reporting beneficial effects on clinical outcomes. Most documents (n = 58) included guidance specific to patients with diabetes mellitus, with fewer including guidance for patients with chronic kidney disease (n = 9) or heart failure (n = 2).

Limitations: Risk of bias was not assessed.

Conclusions: Many resources promoting sick day medication guidance have been developed; however, there is very little empirical evidence for the effectiveness of current approaches in implementing sick day medication guidance into practice. Recommendations for the use of sick day medication guidance will require further research to develop consistent, understandable, and usable approaches for its implementation within self-management strategies as well as empirical studies to demonstrate the effectiveness of these interventions.

Keywords: Cardiovascular disease; chronic conditions; diabetes; hypertension; kidney disease; scoping review; sick day medication guidance; sick day protocol; sick day rules.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses flowchart.

Figure 2

Specific sick day medication guidance by chronic condition. Abbreviations: ACE-i/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker; AKI, acute kidney injury; CKD, chronic kidney disease; DM, diabetes mellitus; GLP-1, glucagon-like peptide 1; HF, heart failure; NSAIDS, nonsteroidal anti-inflammatory drugs; SGLT2-i, sodium/glucose cotransporter 2 inhibitor.

Figure 3

Modes of delivery of patient education on sick day medication guidance. One interactive tool was not described beyond being a safety tool and the other was an insulin dose adjustment tool for parents of children with type 1 diabetes mellitus.