Potentially inappropriate Prescribing for Adults with Diabetes Mellitus: A Scoping Review

Abstract

<p>Inappropriate prescribing is a significant health care management concern and a potential threat to patient safety. People with diabetes mellitus (DM) are at high risk for potentially inappropriate prescribing (PIP) as they often experience multiple comorbidity and polypharmacy. Objective: The aim of this scoping review was to explore and map studies conducted on PIP among people with DM and identify gaps in the study of PIP among this group of people. Methods: PIP was the concept of interest for this scoping review. Studies that reported any type of PIP (contraindication, omission, dosing problem, drug-drug interaction (DDI), inappropriate selection, unnecessary drug therapy) were included. Studies conducted on people aged <18 years of age or with the diagnosis of gestational DM or prediabetes were excluded. No restrictions to language, study design, publication status, geographic area, or clinical setting were applied in selecting the studies. Articles were systematically searched from 11 databases. Results: Among the 190 studies included in this review, the majority (64.0%) were conducted in high income countries. Clinical practice guidelines were the most frequently used standard references for identifying PIP. None of the studies used an explicit tool specifically designed to identify PIP among people with DM. Nearly half (47.4%) of the studies reported contraindications. The most frequently reported PIP in high income countries was contraindication while in low- and middle-income countries prescribing omission was the most common. Software and websites were mostly used for identifying DDIs. The specific events and conditions that were considered as inappropriate were not consistent across the studies. Conclusion: Contraindications, prescribing omissions and dosing problems were the most commonly reported PIPs. Prescribers should carefully consider the individual prescribing recommendations of a medication. Future studies focusing on the development of explicit tools to identify PIP for people with DM are needed.</p>