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Randomized Controlled Trial
. 2025 Aug 1;185(8):926-935.
doi: 10.1001/jamainternmed.2025.2015.

Diabetes Deprescribing in Older Adults: A Randomized Clinical Trial

Richard W Grant  1 , Ilana Peterson  1 , Jodi M McCloskey  1 , Kasia J Lipska  2 , Joshua Nugent  1 , Andrew J Karter  1 , Lisa K Gilliam  3
Affiliations
Randomized Controlled Trial

Diabetes Deprescribing in Older Adults: A Randomized Clinical Trial

Richard W Grant et al. JAMA Intern Med. .

Abstract

Importance: Medication-related hypoglycemia is the leading cause of iatrogenic complications among older adults with type 2 diabetes.

Objective: To compare physician academic detailing (AD) with or without patient previsit activation for insulin and/or sulfonylurea deprescribing in older patients with diabetes.

Design, setting, and participants: This randomized clinical trial was conducted from September 2020 to March 2024 with 6 and 12 months of follow-up in a large integrated health care system in Northern California. Primary care physicians (PCPs) and their patients with type 2 diabetes who were 75 years and older, had hemoglobin A1c of 8.0% or lower, and were treated with insulin and/or sulfonylureas were included.

Interventions: Participating PCPs attended at least 1 AD session that provided evidence to support diabetes medication reassessment and potential deprescribing strategies in older patients with type 2 diabetes. Prior to their visit with a participating PCP, trial patients were randomly assigned to receive either a previsit activation deprescribing handout (AD plus previsit arm) or an attention control healthy lifestyle handout (AD-only arm).

Main outcomes and measures: Primary outcomes (assessed at 6 months) were diabetes medication deprescribing (an aggregate measure) and any patient-reported severe hypoglycemia episodes.

Results: A total of 211 PCPs were able to attend at least 1 AD session and treated 450 eligible patients (mean [SD] age, 79.9 [4.0] years; 223 [49.6%] female; mean [SD] concurrent chronic conditions, 6.2 [3.6]; and mean [SD] hemoglobin A1c, 7.5% [1.1%]). At 6 months, there was a statistically significant higher diabetes medication deprescribing rate in the AD plus previsit activation arm compared with the AD-only arm (36 of 232 patients [15.8%] vs 19 of 218 patients [9.0%]; adjusted risk difference [RD], 7.5%; 95% CI, 1.5%-13.6%; P = .01); this difference persisted at 12 months (50 of 232 patients [22.8%] vs 33 of 218 patients [16.3%]; adjusted RD, 7.9%; 95% CI, 0.4%-15.5%; P = .04). There was not a statistically significant difference in severe self-reported hypoglycemia at 6 months between the AD plus previsit and AD-only arms (10 of 232 patients [4.7%] vs 13 of 218 patients [6.5%]; adjusted RD, -2.3%; 95% CI, -7.1% to 2.5%; P = .04).

Conclusions and relevance: In this randomized clinical trial, AD with previsit activation was a simple and effective strategy for increasing diabetes medication deprescribing in older patients with type 2 diabetes.

Trial registration: ClinicalTrials.gov Identifier: NCT04585191.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lipska reported grants from the National Institute of Diabetes and Digestive and Kidney Diseases, personal fees from UpToDate to write and edit content, and other support from the Centers for Medicare & Medicaid Services to design and evaluate publicly reported quality measures outside the submitted work. Dr Karter reported grants from Dexcom outside the submitted work. No other disclosures were reported.

Comment on

References

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