Previsit Tools Boost Diabetes Deprescribing in Older Adults, Study Finds

Pairing physician academic detailing with patient previsit activation materials significantly increases deprescribing rates, offering a scalable approach to safer diabetes care for older adults who may otherwise be at risk for hypoglycemia from medications like insulin and sulfonylureas.¹

This randomized clinical trial is published in JAMA Internal Medicine.

Combining physician education with patient previsit activation increases deprescribing of diabetes medications, according to one study. | Image credit: greenapple78 - stock.adobe.com

“Diabetes medication deprescribing in older patients with type 2 diabetes is a complex clinical decision-making process,” wrote the researchers of the study. “Individuals of similar chronological age can have wide variation in biological age based on functional capacity, burden of comorbidity, and predicted lifespan. The decision to reduce diabetes medication intensity ideally involves a collaborative conversation between prescribing physician and patient that aligns with the patient’s values and preferences; thus, deprescribing does not lend itself to simple, one-size-fits-all management protocols.”

Diabetes medication deprescribing may involve stopping or reducing the dose of glucose-lowering drugs, switching to alternatives with a more favorable risk–benefit profile, or simplifying complex medication regimens to improve adherence and quality of life.² Deprescribing can also extend to reducing the frequency of self-monitoring blood glucose, scaling back diabetes-specific assessments like urinary albumin creatinine ratio checks, and adjusting or discontinuing other medications such as blood pressure drugs or statins when the benefits no longer clearly outweigh the risks.

The trial was conducted within a large integrated health care system in Northern California from September 2020 to March 2024, with primary care physicians (PCPs) and their older patients with type 2 diabetes (T2D) were enrolled to assess strategies for medication deprescribing.¹ Eligible patients were 75 years or older, had hemoglobin A1C levels of 8.0% or lower, and were being treated with insulin and/or sulfonylureas. Participating PCPs attended at least 1 academic detailing (AD) session that reviewed evidence-based guidance for reassessing diabetes medications in older adults. Patients were then randomly assigned to receive either a previsit deprescribing activation handout (AD plus previsit arm) or a healthy lifestyle handout as an attention control (AD-only arm) prior to their PCP visit.

The primary outcomes of deprescribing of diabetes medications and self-reported severe hypoglycemia were assessed at 6 months, with continued follow-up through 12 months.

A total of 450 eligible patients were included, with a mean (SD) age of 79.9 (4.0) years, and 49.6% were female. These patients were treated by 211 primary care physicians. At 6 months, patients in the AD plus previsit activation arm had significantly higher rates of diabetes medication deprescribing compared with those in the AD-only arm (15.8% vs 9.0%; adjusted risk difference [RD], 7.5%; 95% CI, 1.5%-13.6%; P = .01). This effect was sustained at 12 months, with deprescribing observed in 22.8% of patients in the AD plus previsit arm vs 16.3% in the AD-only arm (adjusted RD, 7.9%; 95% CI, 0.4%-15.5%; P = .04).

Additionally, there was no statistically significant difference in patient-reported severe hypoglycemia between groups at 6 months (4.7% vs 6.5%; adjusted RD, -2.3%; 95% CI, -7.1% to 2.5%; P = .34).

However, the researchers noted several limitations. Both groups received AD, so comparisons relied on external usual care cohorts, which may have led to residual confounding. Additionally, the intervention was delivered virtually due to the pandemic, limiting in-person support. Shared decision-making and patient satisfaction were also not directly assessed. Finally, the study was conducted in a single health system.

Despite these limitations, the researchers believe the study suggests AD is effective in diabetes medication deprescribing in older patients with T2D.

“Further research on deprescribing with larger sample sizes may be required to demonstrate the hypothesized causal link between safe deprescribing and reduced hypoglycemia-related complications,” wrote the researchers. “Next steps in the effort to change diabetes management for older high-risk patients may further benefit from also including system-level and policy-level interventions.”

References

1. Grant RW, Peterson I, McCloskey JM, et al. Diabetes deprescribing in older adults. JAMA Intern Med. doi:10.1001/jamainternmed.2025.2015

2. Ali S. Deprescribing in type 2 diabetes. Diabetes & Primary Care. 2023. Accessed June 20, 2025. https://diabetesonthenet.com/wp-content/uploads/3.-Ali_Deprescribing.pdf