Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study

Melissa M Parker; Kasia J Lipska; Lisa K Gilliam; Richard W Grant; Shanzay Haider; Elbert S Huang; Rajesh K Jain; Neda Laiteerapong; Jennifer Y Liu; Howard H Moffet; Andrew J Karter

doi:10.1111/jgs.19352

Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study

J Am Geriatr Soc. 2025 Jan 9. doi: 10.1111/jgs.19352. Online ahead of print.

Authors

Affiliations

¹ Division of Research, Kaiser Permanente, Pleasanton, California, USA.
² Department of Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA.
³ Department of Endocrinology, Kaiser Permanente, South San Francisco Medical Center, South San Francisco, California, USA.
⁴ Department of Endocrinology, KPC Health-Hemet Global Medical Center, Hemet, California, USA.
⁵ Department of Medicine, The University of Chicago, Chicago, Illinois, USA.
⁶ Department of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, Illinois, USA.
⁷ Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.

PMID: 39781584
DOI: 10.1111/jgs.19352

Abstract

Background: Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of patients' self-reported perspectives with subsequent deprescribing of diabetes medications in older adults with type 2 diabetes.

Methods: Longitudinal cohort study of 1629 pharmacologically treated adults ages 65-100 years with type 2 diabetes who received care at Kaiser Permanente of Northern California (KPNC) and participated in the Diabetes Preferences and Self-Care survey (2019). The survey asked questions about perspectives regarding the use of diabetes medications. Deprescribing was identified during the 24 months following the survey and defined as any of the following: discontinuation of one or more therapeutic classes, reduction in frequency of daily dosing, reduction in total daily pill count, or reduction in total daily dose for oral hypoglycemic agents. Rates of deprescribing and measures of relative risk were calculated for patients' perspectives and select clinical factors. Models predicting deprescribing were adjusted for age, sex, race/ethnicity, health literacy, baseline number of diabetes medications, duration of diabetes, overtreatment per Endocrine Society guidelines, and KPNC eligibility for targeted deprescribing and weighted to account for the age-stratified complex sampling design and survey response.

Results: Six hundred seventy-three (38%) patients experienced deprescribing over a mean follow-up of 23 months. Deprescribing was significantly associated with the following patient perspectives: not expecting to need diabetes medication for life (RR = 1.48, 95% CI: 1.07-2.03) and not recognizing that taking fewer medications could lead to higher blood sugar levels (RR = 1.31, 95% CI: 1.09-1.58).

Conclusions: Patients' perspectives may enable or hinder deprescribing, emphasizing the importance of soliciting these perspectives during shared decision-making. Effective deprescribing will benefit from understanding patients' perspectives and fostering patient-provider communication about medication changes throughout the disease course.

Keywords: deprescribing; diabetes; patient preferences; shared decision making.

Abstract

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