{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:30:51Z","timestamp":1760142651004,"version":"build-2065373602"},"reference-count":80,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diabetology"],"abstract":"<jats:p>Background\/Objectives: Understanding prescribing patterns for type 2 diabetes mellitus, a complex condition affecting over 10% of the global adult population, can optimise 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 the prescription and non-prescription of metformin, the recommended first-line therapy in Western guidelines, and to evaluate whether these prescribing patterns align with evidence-based recommendations. It also explores factors associated with initial combination therapy, a more recent and controversial approach compared to stepwise therapy. Methods: We conducted a systematic search in PubMed, Scopus, and Web of Science on 25 August 2023, without language or time restrictions, to identify observational analytical studies assessing factors associated with the initiation of metformin or combination therapy in adults with type 2 diabetes mellitus who were na\u00efve to antidiabetic medications. Studies involving pregnant or breastfeeding women were excluded. A narrative synthesis was conducted. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklists (PROSPERO registration number CRD42023438313). Results: Thirty studies were included, evaluating 105 variables, most of which (62%) were assessed in one study. The 25 variables using combination therapy as the outcome were mostly (72%) evaluated also in one study. Initial metformin prescription was strongly and positively associated with younger age, lower glycated haemoglobin levels, higher body mass index, and absence of renal impairment. Initial combination therapy was associated with higher HbA1c levels and a lower burden of 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. Conclusions: Our systematic review, which 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 in this field.<\/jats:p>","DOI":"10.3390\/diabetology6100114","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:54:31Z","timestamp":1760028871000},"page":"114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Influencing the Prescription of First-Line Treatment for Type 2 Diabetes Mellitus: A Systematic Review"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2477-482X","authenticated-orcid":false,"given":"Helena","family":"Silva-Moreira","sequence":"first","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Science, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"},{"name":"Escola Superior de Sa\u00fade, Instituto Polit\u00e9cnico do Porto, Rua Dr. Ant\u00f3nio Bernardino de Almeida 400, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-1459","authenticated-orcid":false,"given":"Fernando","family":"Moreira","sequence":"additional","affiliation":[{"name":"REQUIMTE\/LAQV, Escola Superior de Sa\u00fade, Instituto Polit\u00e9cnico do Porto, Rua Dr. Ant\u00f3nio Bernardino de Almeida, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3972-8253","authenticated-orcid":false,"given":"\u00c2ngelo","family":"Jesus","sequence":"additional","affiliation":[{"name":"REQUIMTE\/LAQV, Escola Superior de Sa\u00fade, Instituto Polit\u00e9cnico do Porto, Rua Dr. Ant\u00f3nio Bernardino de Almeida, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro-Soares","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Science, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"},{"name":"Escola Superior de Sa\u00fade da Cruz Vermelha Portuguesa\u2014Lisboa, 1300-125 Lisbon, Portugal"},{"name":"CrossI&D: Lisbon Research Center, Escola Superior de Sa\u00fade da Cruz Vermelha Portuguesa\u2014Lisboa, 1300-125 Lisbon, Portugal"},{"name":"RISE@CINTESIS: Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2362-5527","authenticated-orcid":false,"given":"Paulo","family":"Santos","sequence":"additional","affiliation":[{"name":"MEDCIDS\u2014Department of Community Medicine, Information and Health Decision Science, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"},{"name":"RISE@CINTESIS: Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K.B., Ostolaza, H., and Mart\u00edn, C. (2020). Pathophysiology of type 2 diabetes mellitus. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21176275"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"108086","DOI":"10.1016\/j.diabres.2020.108086","article-title":"Mortality attributable to diabetes in 20-79 years old adults, 2019 estimates: Results from the International Diabetes Federation Diabetes Atlas, 9th edition","volume":"162","author":"Saeedi","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.2337\/dci22-0034","article-title":"Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"45","author":"Davies","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e001279","DOI":"10.1136\/bmjdrc-2020-001279","article-title":"Long-term trends in the prescription of antidiabetic drugs: Real-world evidence from the Diabetes Registry Tyrol 2012-2018","volume":"8","author":"Engler","year":"2020","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1016\/j.clinthera.2017.09.016","article-title":"Factors Associated with Type 2 Diabetes Mellitus Treatment Choice Across Four European Countries","volume":"39","author":"Heintjes","year":"2017","journal-title":"Clin. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1111\/dom.13830","article-title":"Treatment patterns and associated factors in 14 668 people with type 2 diabetes initiating a second-line therapy: Results from the global DISCOVER study programme","volume":"21","author":"Nicolucci","year":"2019","journal-title":"Diabetes Obes. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S137","DOI":"10.2337\/dcS15-3007","article-title":"Clinical considerations for use of initial combination therapy in type 2 diabetes","volume":"39","author":"Cahn","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.healthpol.2013.08.002","article-title":"A systematic review of medical practice variation in OECD countries","volume":"114","author":"Corallo","year":"2014","journal-title":"Health Policy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/S0140-6736(13)61215-5","article-title":"Understanding of regional variation in the use of surgery","volume":"382","author":"Birkmeyer","year":"2013","journal-title":"Lancet"},{"key":"ref_11","first-page":"795","article-title":"Factors Influencing Prescribing Decisions of Physicians: A Review","volume":"28","author":"Davari","year":"2018","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ijantimicag.2012.09.003","article-title":"Understanding physician antibiotic prescribing behaviour: A systematic review of qualitative studies","volume":"41","author":"Rodrigues","year":"2013","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee 9 (2022). Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022. Diabetes Care, 45, S125\u2013S143.","DOI":"10.2337\/dc22-S009"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Raets, L., Ingelbrecht, A., and Benhalima, K. (2023). Management of type 2 diabetes in pregnancy: A narrative review. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1193271"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S254","DOI":"10.2337\/dc23-S015","article-title":"15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_18","unstructured":"Aromataris, E., and Munn, Z. (2020). JBI Manual for Evidence Synthesis, JBI. Epub ahead of print."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1002\/pds.2262","article-title":"Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor-based electronic health record","volume":"21","author":"Brouwer","year":"2012","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1463-1326.2011.01498.x","article-title":"Time to treatment initiation with oral antihyperglycaemic therapy in US patients with newly diagnosed type 2 diabetes","volume":"14","author":"Zhang","year":"2012","journal-title":"Diabetes Obes. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sinclair, A.J., Alexander, C.M., Davies, M.J., Zhao, C., and Mavros, P. (2012). Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes. BMC Endocr. Disord., 12.","DOI":"10.1186\/1472-6823-12-1"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1177\/1060028013503624","article-title":"Initial Antihyperglycemic Drug Therapy Among 241 327 Adults With Newly Identified Diabetes From 2005 Through 2010: A Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) Study","volume":"47","author":"Raebel","year":"2013","journal-title":"Ann. Pharmacother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.diabres.2014.07.014","article-title":"Patterns and determinants of new first-line antihyperglycaemic drug use in patients with type 2 diabetes mellitus","volume":"106","author":"Geier","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_24","unstructured":"Wright, A.K. (2014). Examining Drug Utilisation Patterns and Optimal Treatment Pathways of Antidiabetic Medications, The University of Manchester. Available online: https:\/\/pure.manchester.ac.uk\/ws\/portalfiles\/portal\/54566935\/FULL_TEXT.PDF."},{"key":"ref_25","unstructured":"Li, Y. (2019). Factors Associated with Initiation of Glucose-Lowering Agents Among Medicare Beneficiaries with Newly Diagnosed Type 2 Diabetes, 2007\u20132017, University of Pittsburgh. Epub ahead of print."},{"key":"ref_26","unstructured":"Carrillo Balam, G.G. (2020). Glucose-Lowering Medication Initiation in People with Newly Diagnosed Type 2 Diabetes in Scotland: A Mixed-Methods Study, The University of Edinburgh."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"110777","DOI":"10.1016\/j.diabres.2023.110777","article-title":"Longitudinal treatment patterns in patients recently diagnosed with type 2 diabetes mellitus in Catalonia","volume":"202","author":"Ouchi","year":"2023","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/pds.2059","article-title":"Guideline-conformity of initiation with oral hypoglycemic treatment for patients with newly therapy-dependent type 2 diabetes mellitus in Austria","volume":"20","author":"Winkelmayer","year":"2011","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.amjmed.2011.07.033","article-title":"Patterns of medication initiation in newly diagnosed diabetes mellitus: Quality and cost implications","volume":"125","author":"Desai","year":"2012","journal-title":"Am. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1111\/bcp.12573","article-title":"Initial therapy, persistence and regimen change in a cohort of newly treated type 2 diabetes patients","volume":"79","author":"Grimes","year":"2014","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jcjd.2013.04.008","article-title":"Use patterns of antidiabetic regimens by patients with type2 diabetes","volume":"37","author":"Abdelmoneim","year":"2013","journal-title":"Can. J. Diabetes"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wang, T.-Y., Eguale, T., and Tamblyn, R. (2013). Guidelines adherence in the treatment of patients with newly diagnosed type 2 diabetes: A historical cohort comparing the use of metformin in Quebec pre and post-Canadian Diabetes Association guidelines. BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-442"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1185\/03007995.2013.827108","article-title":"Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus","volume":"29","author":"Mitchell","year":"2013","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_34","first-page":"2036","article-title":"Learning Effective Treatment Pathways for Type-2 Diabetes from a clinical data warehouse","volume":"2016","author":"Vashisht","year":"2016","journal-title":"AMIA Annu. Symp. Proc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e6122","DOI":"10.1097\/MD.0000000000006122","article-title":"Comparison of baseline characteristics and clinical course in Japanese patients with type 2 diabetes among whom different types of oral hypoglycemic agents were chosen by diabetes specialists as initial monotherapy (JDDM 42)","volume":"96","author":"Fujihara","year":"2017","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/jdi.12567","article-title":"Prescription of oral hypoglycemic agents for patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database","volume":"8","author":"Tanabe","year":"2017","journal-title":"J. Diabetes Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.puhe.2017.06.008","article-title":"Prescription trends and the selection of initial oral antidiabetic agents for patients with newly diagnosed type 2 diabetes: A nationwide study","volume":"152","author":"Liu","year":"2017","journal-title":"Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s13098-019-0486-y","article-title":"Treatment patterns of drug-naive patients with type 2 diabetes mellitus: A retrospective cohort study using a Japanese hospital database","volume":"11","author":"Morita","year":"2019","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"375","DOI":"10.20344\/amp.10414","article-title":"Initial Therapeutic Choices for Type 2 Diabetes in the Portuguese Sentinel Practice Network","volume":"32","author":"Pinto","year":"2019","journal-title":"Acta Med. Port."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Juste, A.M., Menditto, E., Orlando, V., Monetti, V.M., Miguel, A.G., Rubio, F.G., Aza-Pascual-Salcedo, M.M., Cahir, C., Torres, A.P., and Riccardi, G. (2019). Treatment patterns of diabetes in Italy: A population-based study. Front. Pharmacol., 10.","DOI":"10.3389\/fphar.2019.00870"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Moreno-Juste, A., Poblador-Plou, B., Aza-Pascual-Salcedo, M., Gonz\u00e1lez-Rubio, F., Malo, S., L\u00f3pez, J.L., Pico-Soler, V., Labrador, E.G., Mucherino, S., and Orlando, V. (2020). Initial therapy, regimen change, and persistence in a spanish cohort of newly treated type 2 diabetes patients: A retrospective, observational study using real-world data. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103742"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e001361","DOI":"10.1136\/bmjdrc-2020-001361","article-title":"Real-world Observational Study on Patient Outcomes in Diabetes (RESPOND): Study design and baseline characteristics of patients with type 2 diabetes newly initiating oral antidiabetic drug monotherapy in Japan","volume":"8","author":"Yabe","year":"2020","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1111\/dme.14149","article-title":"Pharmacological treatment initiation for type 2 diabetes in Australia: Are the guidelines being followed?","volume":"37","author":"Wood","year":"2020","journal-title":"Diabet. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e14622","DOI":"10.1111\/dme.14622","article-title":"First-line pharmacotherapy for incident type 2 diabetes: Prescription patterns, adherence and associated costs","volume":"38","author":"Campbell","year":"2021","journal-title":"Diabet. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.2337\/dc20-2926","article-title":"Trends in First-Line Glucose-Lowering Drug Use in Adults With Type 2 Diabetes in Light of Emerging Evidence for SGLT-2i and GLP-1RA","volume":"44","author":"Shin","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.1016\/j.numecd.2021.06.006","article-title":"Initial treatment of diabetes in Italy. A nationwide population-based study from of the ARNO Diabetes Observatory","volume":"31","author":"Bonora","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_47","first-page":"153","article-title":"Do Glucagonlike Peptide-1 Receptor Agonist and Sodium-glucose Co-transporter 2 Inhibitor Prescriptions in Germany Reflect Recommendations for Type 2 Diabetes with Cardiovascular Disease of the ADA\/EASD Consensus Report?","volume":"131","author":"Barth","year":"2022","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/jdi.13636","article-title":"Retrospective nationwide study on the trends in first-line antidiabetic medication for patients with type 2 diabetes in Japan","volume":"13","author":"Bouchi","year":"2022","journal-title":"J. Diabetes Investig."},{"key":"ref_49","unstructured":"Hulley, S.B., Cummings, S.R., Browner, W.S., Grady, D.G., and Newman, T.B. (2013). Designing Clinical Research, Lippincott Williams & Wilkins. Epub ahead of print."},{"key":"ref_50","unstructured":"Centers for Medicare & Medicaid Services (2024, December 07). What\u2019s Medicare?, Available online: https:\/\/www.medicare.gov\/."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/s12933-022-01712-4","article-title":"Management of type 2 diabetes with a treat-to-benefit approach improved long-term cardiovascular outcomes under routine care","volume":"21","author":"Morieri","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, and Cheng, A.Y.Y. (2018). Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can. J. diabetes, 42, S1\u2013S325.","DOI":"10.1016\/S1499-2671(17)31026-2"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/jdi.13306","article-title":"Japanese Clinical Practice Guideline for Diabetes 2019","volume":"11","author":"Araki","year":"2020","journal-title":"J. Diabetes Investig."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Mardetko, N., Nabergoj Makovec, U., Locatelli, I., Janez, A., and Kos, M. (2021). Uptake of new antidiabetic medicines in 11 European countries. BMC Endocr. Disord., 21.","DOI":"10.1186\/s12902-021-00798-3"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e000686","DOI":"10.1136\/bmjph-2023-000686","article-title":"Diabetes control in public assistance recipients and free\/low-cost medical care program beneficiaries in Japan: A retrospective cross-sectional study","volume":"2","author":"Funakoshi","year":"2024","journal-title":"BMJ Public Health"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"599","DOI":"10.2147\/CEOR.S116570","article-title":"Bringing patient centricity to diabetes medication access in Canada","volume":"8","author":"Glennie","year":"2016","journal-title":"Clinicoecon. Outcomes Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.1093\/eurheartj\/ehad192","article-title":"2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes","volume":"44","author":"Marx","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s13098-019-0476-0","article-title":"Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases","volume":"11","author":"Bashier","year":"2019","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jsps.2021.12.019","article-title":"Prescribing patterns of antidiabetics in type 2 diabetes and factors affecting them","volume":"30","author":"Allyhiani","year":"2022","journal-title":"Saudi Pharm. J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1001\/archinte.160.1.98","article-title":"Understanding physician adherence with a pneumonia practice guideline: Effects of patient, system, and physician factors","volume":"160","author":"Halm","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Grustam, A., Jovic Vranes, A., Soldatovic, I., Stojicic, P., and Jovanovic Andersen, Z. (2020). Factors Associated with Utilization of Primary and Specialist Healthcare Services by Elderly Cardiovascular Patients in the Republic of Serbia: A Cross-Sectional Study from the National Health Survey 2013. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17072602"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Qi, M., Santos, H., Pinheiro, P., McGuinness, D.L., and Bennett, K.P. (2023). Demographic and socioeconomic determinants of access to care: A subgroup disparity analysis using new equity-focused measurements. PLoS ONE, 18.","DOI":"10.1101\/2023.04.28.23289172"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.diabres.2015.02.027","article-title":"Why physicians do not initiate dual therapy as recommended by AACE guidelines: A survey of clinicians in the United States","volume":"108","author":"Qiu","year":"2015","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Diabetes Prevention Program Research Group (2012). Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care, 35, 731\u2013737.","DOI":"10.2337\/dc11-1299"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Lv, Z., and Guo, Y. (2020). Metformin and Its Benefits for Various Diseases. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00191"},{"key":"ref_66","first-page":"579","article-title":"Hypoglycemia induced by antidiabetic sulfonylureas","volume":"119","author":"Confederat","year":"2015","journal-title":"Rev. Med. Chir. Soc. Med. Nat. Iasi"},{"key":"ref_67","unstructured":"National Institute for Health and Care Excellence (NICE) (2015). Type 2 Diabetes in Adults: Management. NICE Guideline [NG28], NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/ng28."},{"key":"ref_68","unstructured":"Dire\u00e7\u00e3o-Geral da Sa\u00fade (2024, September 12). Abordagem Terap\u00eautica Farmacol\u00f3gica na Diabetes Mellitus Tipo 2 no Adulto. Norma DGS No.052\/2011 Updated 27 April 2015; pp. 1\u201328. Available online: https:\/\/www.mgfamiliar.net\/wp-content\/uploads\/NOC_Diabetes_2015-3.pdf."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"629","DOI":"10.2337\/dci17-0003","article-title":"Modern Sulfonylureas: Dangerous or Wrongly Accused?","volume":"40","author":"Riddle","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00125-013-2856-6","article-title":"Estimating the effect of sulfonylurea on HbA1c in diabetes: A systematic review and meta-analysis","volume":"56","author":"Hirst","year":"2013","journal-title":"Diabetologia"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s00125-008-1157-y","article-title":"Medical management of hyperglycaemia in type 2 diabetes mellitus: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes","volume":"52","author":"Nathan","year":"2009","journal-title":"Diabetologia"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1007\/s13300-020-00871-5","article-title":"Prescription of Sulphonylureas among Patients with Type 2 Diabetes Mellitus in Italy: Results from the Retrospective, Observational Multicentre Cross-Sectional SUSCIPE (Sulphonyl_UreaS_Correct_Internal_Prescription_Evaluation) Study","volume":"11","author":"Giorda","year":"2020","journal-title":"Diabetes Ther."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s11892-014-0473-5","article-title":"Sulfonylureas: A new look at old therapy","volume":"14","author":"Umpierrez","year":"2014","journal-title":"Curr. Diab. Rep."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"547","DOI":"10.2337\/dc17-2231","article-title":"Metformin Treatment in Patients With Type 2 Diabetes and Chronic Kidney Disease Stages 3A, 3B, or 4","volume":"41","author":"Lalau","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"554","DOI":"10.7326\/0003-4819-154-8-201104190-00007","article-title":"Individualizing glycemic targets in type 2 diabetes mellitus: Implications of recent clinical trials","volume":"154","author":"Moghissi","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_76","first-page":"e38","article-title":"Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association","volume":"133","author":"Mozaffarian","year":"2016","journal-title":"Circulation"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: An update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. Suppl."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s10198-017-0926-2","article-title":"Determinants of health care costs in the senior elderly: Age, comorbidity, impairment, or proximity to death?","volume":"19","author":"Hazra","year":"2018","journal-title":"Eur. J. Health Econ."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"afac155","DOI":"10.1093\/ageing\/afac155","article-title":"Association between multimorbidity and hospitalization in older adults: Systematic review and meta-analysis","volume":"51","author":"Rodrigues","year":"2022","journal-title":"Age Ageing"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e13997","DOI":"10.1111\/eci.13997","article-title":"Meta-analysis of factors associated with antidiabetic drug prescribing for type 2 diabetes mellitus","volume":"53","author":"Mahmoud","year":"2023","journal-title":"Eur. J. Clin. 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