Benefits of a Deprescribing Program Within an Integrated Health System

Within an integrated health care system, a pharmacist-managed deprescribing program, which focused on select antidiabetics among older patients with well-controlled type 2 diabetes, resulted in sustained benefit after one year in reducing the risk of hypoglycemia and mortality compared with usual care.   

“While there are studies detailing strategies to deprescribe benzodiazepines and antipsychotics in nursing homes or in those with dementia, there is a lack of guidance and evidence to safely deprescribe chronic medications, such as antidiabetics, for older patients in the community setting,” wrote study authors Ruth Hui, PharmD, and colleagues. 

To compare the effectiveness and safety outcomes between a pharmacist-managed deprescribing program and usual care on selected antidiabetic medications, Dr Hui and colleagues conducted a retrospective propensity score-matched cohort study. Patients enrolled in the study were split into two groups, the deprescribing group and usual care group. Patients were followed for one year or the end of membership or death, whichever occurred first. The research team measured effectiveness by the incidence of hypoglycemia that required acute care and death. The safety outcomes that were measured included incidence rate of hypoglycemia requiring acute care, proportion of patients at goal hemoglobin A1c (HbA1c) <7% and change in HbA1c.  

Following the propensity score match, 685 patients in the deprescribing group and 2055 patients in the usual care group were similar in age, gender, weight, and comorbidity burden (mean age 82.4 ± 5.4 years old, 48% female, mean weight 81.7 ± 19.2 kg, mean Charlson Comorbidity Index 3.2 ± 1.6).

According to the findings, the deprescribing group had a significant lower incidence rate of hypoglycemia, lower mortality rate, and greater change in HbA1c, compared with the usual care group. Further, there were no differences in the incidence rate of hyperglycemia and proportion of patients at goal HbA1c.  

“This study showed that deprescribing of selected antidiabetics in older patients with well-controlled type 2 diabetes had sustained benefit after one year in reducing the risk of hypoglycemia and mortality,” concluded Dr Hui and colleagues. “This was accomplished without elevating the risk for hyperglycemia nor negatively impacting the proportion of patients at goal HbA1c.” —Julie Gould