Pickering Aimee N, Richardson Sam, Rogal Shari, Thorpe Carolyn T, Brach Jennifer, Radomski Thomas R
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Center for Biostatistics and Qualitative Methodology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2025 Aug;73(8):2447-2456. doi: 10.1111/jgs.19550. Epub 2025 Jun 5.
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.
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.
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.
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.
超过半数的老年糖尿病患者仍在使用过度强化或不适当的药物治疗方案来治疗糖尿病及相关并发症，这导致了药物不良事件、多重用药，以及住院和死亡风险的增加。本研究旨在确定该人群中减少糖尿病药物处方的促进因素和障碍。
我们对15名年龄在65岁及以上且正在使用至少一种高风险降糖药物（如磺脲类）或可能不适当的药物治疗糖尿病相关周围神经病变（如三环类抗抑郁药）的糖尿病成年人，以及10名符合纳入标准的老年成年人的家庭照顾者进行了15次半结构化访谈。访谈探讨了参与者对糖尿病药物的总体看法，以及遵循处方者减少糖尿病药物处方建议的障碍和促进因素。访谈进行了录音并逐字转录。研究团队的两名成员制定了编码手册，对转录本进行编码，并协调任何差异。然后我们进行了主题分析以确定关键主题。
我们确定了影响患者和照顾者观点的各种因素，我们将其分为四组：与患者、处方者、药物和过程相关的促进因素和障碍。与患者相关的促进因素包括对处方者理由的理解以及尽量减少用药的偏好，而障碍包括对负面后果的恐惧。与处方者相关的促进因素包括信任、对护理的感知投入、感知的专业知识以及与其他处方者的合作。与药物相关的障碍包括感知到的益处以及缺乏影响生活质量的副作用。最后，与过程相关的促进因素包括逐步减少药物剂量、详细的随访计划以及必要时重新开始用药的选择。
我们确定了影响患者和照顾者减少糖尿病药物处方意愿的关键促进因素和障碍。我们的研究结果将为制定有针对性的策略提供信息，以支持老年患者减少糖尿病药物处方。
