Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study.

BACKGROUND

Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of patients' self-reported perspectives with subsequent deprescribing of diabetes medications in older adults with type 2 diabetes.

METHODS

Longitudinal cohort study of 1629 pharmacologically treated adults ages 65-100 years with type 2 diabetes who received care at Kaiser Permanente of Northern California (KPNC) and participated in the Diabetes Preferences and Self-Care survey (2019). The survey asked questions about perspectives regarding the use of diabetes medications. Deprescribing was identified during the 24 months following the survey and defined as any of the following: discontinuation of one or more therapeutic classes, reduction in frequency of daily dosing, reduction in total daily pill count, or reduction in total daily dose for oral hypoglycemic agents. Rates of deprescribing and measures of relative risk were calculated for patients' perspectives and select clinical factors. Models predicting deprescribing were adjusted for age, sex, race/ethnicity, health literacy, baseline number of diabetes medications, duration of diabetes, overtreatment per Endocrine Society guidelines, and KPNC eligibility for targeted deprescribing and weighted to account for the age-stratified complex sampling design and survey response.

RESULTS

Six hundred seventy-three (38%) patients experienced deprescribing over a mean follow-up of 23 months. Deprescribing was significantly associated with the following patient perspectives: not expecting to need diabetes medication for life (RR = 1.48, 95% CI: 1.07-2.03) and not recognizing that taking fewer medications could lead to higher blood sugar levels (RR = 1.31, 95% CI: 1.09-1.58).

CONCLUSIONS

Patients' perspectives may enable or hinder deprescribing, emphasizing the importance of soliciting these perspectives during shared decision-making. Effective deprescribing will benefit from understanding patients' perspectives and fostering patient-provider communication about medication changes throughout the disease course.