Factors influencing the prescription of first-line treatment for type 2 diabetes mellitus: a systematic review
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Introduction
Understanding and predicting prescription preferences for type 2 diabetes mellitus, a heterogeneous and complex condition that affects over 10% of the global adult population, can improve prescribing practices, guide policymakers in promoting evidence-based medicine, and help tailor first-line treatments to individual characteristics or specific subgroups, improving patient outcomes. This study aimed to identify factors influencing metformin prescription, the first-line therapy recommended in Western guidelines, and to assess factors leading to its avoidance and their alignment with evidence-based medicine. It also explores factors associated with initial combination therapy, a newer and controversial approach compared to stepwise therapy.
Methods
We performed a systematic search in PubMed, Scopus and Web of Science for observational analytical studies evaluating factors associated with metformin or combination therapy initiation. Quality assessment was done using the Joanna Briggs Institute critical appraisal checklists. (PROSPERO registry number CRD42023438313 ).
Results
Thirty studies were included, evaluating 105 variables, mostly (62%) assessed in one study. The 25 variables using combination therapy as outcome were mostly (72%) evaluated also in one study. Initial metformin prescription was strongly associated with the age of individuals with diabetes, glycated haemoglobin levels, body mass index, and renal complications, while combination therapy was mainly linked with glycated haemoglobin levels and comorbidities. Findings also highlighted a discrepancy between clinical practice and evidence-based recommendations. However, concerns were raised regarding both the internal and external validity of the included studies.
Conclusion
Our systematic review, that offers insights into real-world clinical practices, indicated that there is a misalignment between clinical practices and evidence-based recommendations supporting the need for interventions of this field.
