Individualizing glycemic targets to goals of care and time to benefit in persons with type 2 diabetes is good practice, particularly in populations at risk of hypoglycemia and adverse outcomes relating to the use of antihyperglycemics. Guidelines acknowledge the need for relaxed targets in frail older adults, but there is little guidance on how to safely deprescribe (i.e. stop, reduce or substitute) antihyperglycemics.
The purpose of this study was to synthesize evidence from all studies evaluating the effects of deprescribing versus continuing antihyperglycemics in older adults with type 2 diabetes. To this end, we searched MEDLINE, EMBASE, and Cochrane Library (July 2015) for controlled studies evaluating the effects of deprescribing antihyperglycemics in adults with type 2 diabetes. All such studies were eligible for inclusion in our study, and two independent reviewers screened titles, abstracts and full-text articles, extracted data, and evaluated risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment and a narrative summary were completed.
We identified two controlled before-and-after studies, both of very low quality. One study found that an educational intervention decreased glyburide use while not compromising glucose control. The other reported that cessation of antihyperglycemics in elderly nursing home patients resulted in a non-significant increase in glycated hemoglobin (HbA1C). No significant change in hypoglycemia rate was found in the only study with this outcome measure.
There is limited evidence available regarding deprescribing antihyperglycemic medications. Adequately powered, high-quality studies, particularly in the elderly and with clinically important outcomes, are required to support evidence-based decision-making.
Supplementary material 1 (DOCX 31 kb)13300_2016_220_MOESM1_ESM.docx
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2013;37[Suppl 1]:S1–212.
Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.
Black C, Thompson W, Lochnan H, McCarthy L, Rojas-Fernandez C, Shamji S, et al. Benefits and harms of deprescribing versus continuing antihyperglycemics for treatment of Type 2 Diabetes Mellitus: a systematic review protocol. PROSPERO. 2015;CRD4201502. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025727.
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.
Sjöblom P, AndersTengblad Löfgren U-B, Lannering C, Anderberg N, Rosenqvist U, et al. Can diabetes medication be reduced in elderly patients? An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control. Diabetes Res Clin Pract. 2008;82(2):197–202. CrossRefPubMed
Aspinall SL, Zhao X, Good CB, Stone RA, Boresi J, Cox S, et al. Intervention to decrease glyburide use in elderly patients with renal insufficiency. Am J Geriatr Pharmacother. 2011;9(1):58–68.
Sussman JB, Kerr E, Saini SD, Holleman RG, Klamerus ML, Min LC, et al. Rates of deintensification of blood pressure and glycemic medication treatment based on levels of control and life expectancy in older patients with diabetes mellitus. JAMA Intern Med. 2015;175(12):1–8. CrossRef
Skoff R, Waterbury N, Shaw R, Egge J, Cantrell M. Glycemic control and hypoglycemia in Veterans Health Administration patients coverted from glyburide to glipizide. J Manag Care Pharm. 2011;17(9):664–71. PubMed
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Higgins JP, Green S, editors. Cochrane Collab 2011. John Wiley & Sons; 2011.
- Lack of Evidence to Guide Deprescribing of Antihyperglycemics: A Systematic Review
Cody D. Black
- Springer Healthcare
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