Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

The Reasons for Low Uptake of New Antidiabetic Drugs with Cardiovascular Effects – a Family Doctor Perspective: Does Limited Applicability of Clinical Guidelines in Real-Life Practice Matter? A Narrative Review

Tomislav Kurevija
ORCID logo ,
Dunja Šojat
ORCID logo ,
Zvonimir Bosnić
ORCID logo ,
Blerim Mujaj
,
Silvija Canecki-Varžić
,
Ljiljana Majnarić Trtica
* ORCID logo
Version 1 : Received: 27 February 2024 / Approved: 28 February 2024 / Online: 28 February 2024 (10:53:42 CET)

A peer-reviewed article of this Preprint also exists.

Kurevija, T.; Šojat, D.; Bosnić, Z.; Mujaj, B.; Canecki Varžić, S.; Majnarić Trtica, L. The Reasons for the Low Uptake of New Antidiabetic Drugs with Cardiovascular Effects—A Family Doctor Perspective. J. Clin. Med. 2024, 13, 1617. Kurevija, T.; Šojat, D.; Bosnić, Z.; Mujaj, B.; Canecki Varžić, S.; Majnarić Trtica, L. The Reasons for the Low Uptake of New Antidiabetic Drugs with Cardiovascular Effects—A Family Doctor Perspective. J. Clin. Med. 2024, 13, 1617.

Abstract

Chronic diseases, such as type 2 diabetes (T2D), are difficult to manage because they demand continuous therapeutic review and monitoring. Beyond achieving the target HbA1c, new guidelines for the therapy of T2D have been introduced with the new groups of antidiabetics (GLP-1ra and SGLT2-in). Despite new guidelines, clinical inertia, that can be caused by physicians, patients or healthcare system, results in T2D not being effectively managed. This opinion paper explores the shift in T2D treatment, challenging assumptions and evidence-based recommendations, particularly for family physicians, considering the patient's overall situation in decision-making. We looked for the possible reasons of clinical inertia and poor application of guidelines in the management of T2D. Guidelines for antidiabetic drugs should be more precise, providing case studies and clinical examples to define clinical contexts and contraindications. Knowledge communication can improve confidence and should include clear statements on areas of decision-making not supported by evidence. Precision medicine initiative in diabetes aims to identify subcategories of T2D patients (including frail patients) using clustering techniques from data science applications, focusing on CV and poor treatment outcomes. Clear, unconditional recommendations for personalized T2D management may encourage drug prescription, especially for family physicians dealing with diverse patient contexts and clinical settings.

Keywords

type 2 diabetes; therapeutic inertia; clinical guidelines; sodium-glucose cotransporter-2 inhibitors; glucagon-like peptide-1 receptor agonists; primary health care

Subject

Medicine and Pharmacology, Endocrinology and Metabolism

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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