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Practice Guideline
. 2017 Nov;63(11):832-843.

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Barbara Farrell  1 , Cody Black  2 , Wade Thompson  3 , Lisa McCarthy  4 , Carlos Rojas-Fernandez  5 , Heather Lochnan  6 , Salima Shamji  7 , Ross Upshur  8 , Manon Bouchard  9 , Vivian Welch  10
Affiliations
Practice Guideline

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Barbara Farrell et al. Can Fam Physician. 2017 Nov.

Abstract

Objective: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults.

Methods: We focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest. We used a rigorous process, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, for guideline development. We conducted a systematic review to assess evidence for the benefits and harms of deprescribing antihyperglycemic agents. We performed a review of reviews of the harms of continued antihyperglycemic medication use, and narrative syntheses of patient preferences and resource implications. We used these syntheses and GRADE quality-of-evidence ratings to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. A decision-support algorithm was developed to accompany the guideline.

Recommendations: We recommend deprescribing antihyperglycemic medications known to contribute to hypoglycemia in older adults at risk or in situations where antihyperglycemic medications might be causing other adverse effects, and individualizing targets and deprescribing accordingly for those who are frail, have dementia, or have a limited life expectancy.

Conclusion: This guideline provides practical recommendations for making decisions about deprescribing antihyperglycemic agents. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.

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Figures

Figure 1.
Figure 1.
Antihyperglycemics Deprescribing Algorithm
Figure 1.
Figure 1.
Antihyperglycemics Deprescribing Algorithm
See this image and copyright information in PMC

References

    1. Public Health Agency of Canada . Diabetes in Canada. Facts and figures from a public health perspective. Ottawa, ON: Public Health Agency of Canada; 2011.
    1. Pkrl JJ. The demographics of aging.... Transgenerational Design Matters. 2011. Available from: http://transgenerational.org/aging/demographics.htm. Accessed 2017 Jul 5.
    1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53. Erratum in: Lancet 1999;354(9178):602. - PubMed
    1. ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. Epub 2008 Jun 6. - PubMed
    1. Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in older people—a less well recognized risk factor for frailty. Aging Dis. 2015;6(2):156–67. - PMC - PubMed

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