Facilitators of and Barriers to Deprescribing Diabetes Medications in Older Adults: A Qualitative Study.

BACKGROUND

Over half of older adults with diabetes remain on overly intensive or inappropriate medication regimens to treat diabetes and related complications, leading to adverse drug events, polypharmacy, and increased risk of hospitalization and death. This study aimed to identify facilitators and barriers to deprescribing diabetes medications in this population.

METHODS

We conducted 15 semi-structured interviews with adults aged 65 and older with diabetes who were on at least one high-risk hypoglycemic medication (e.g., sulfonylurea) or potentially inappropriate medication to treat diabetes-related peripheral neuropathy (e.g., tricyclic antidepressant) and 10 family caregivers of older adults meeting inclusion criteria. Interviews explored participants' general perspectives on diabetes medications, as well as barriers to and facilitators of following a prescriber's recommendation to deprescribe a diabetes medication. Interviews were audio recorded and transcribed verbatim. Two members of the research team developed a codebook, coded the transcripts, and reconciled any discrepancies. We then conducted a thematic analysis to identify key themes.

RESULTS

We identified various factors influencing the views of patients and caregivers, which we categorized into four groups: patient-, prescriber-, medication-, and process-related facilitators and barriers. Patient-related facilitators included understanding of prescriber rationale and preference to minimize medications, while barriers included fear of negative consequences. Prescriber-related facilitators included trust, perceived investment in care, perceived expertise, and collaboration with other prescribers. Medication-related barriers included perceived benefit and a lack of side effects impacting quality of life. Lastly, process-related facilitators included a gradual reduction of medications, a detailed follow-up plan, and the option to restart the medication if necessary.

CONCLUSION

We identified key facilitators and barriers that influence patients' and caregivers' willingness to have diabetes medications deprescribed. Our findings will inform the development of targeted strategies to support deprescribing diabetes medications in older adults.