Patients with type 2 diabetes treated in primary care practices with access to lifestyle medicine sometimes underwent deprescribing of glucose-lowering medications, with reductions in body mass index, glucose, and hemoglobin A1c observed during follow-up and no serious adverse events identified, according to a retrospective chart review.
Researchers reviewed electronic health records from 650 patients with type 2 diabetes treated at two primary care practices between 2014 and 2023, identifying 41 confirmed deprescribing events, representing about 6% of the cohort.
Among patients with available follow-up data, mean body mass index decreased by about 2 kg/m² over a mean follow-up of 47 months. Mean glucose decreased by 25% and hemoglobin A1c by 13% among patients who underwent deprescribing, after adjustment for age, sex, and time between measurements.
Deprescribing included dose reductions, discontinuations, or transitions of glucose-lowering medications, based on a structured framework. The most common medication changes were metformin dose reduction (34%), metformin discontinuation (20%), and insulin dose reduction (20%). In some cases, patients transitioned from insulin to oral agents or from multiple medications to metformin alone or no medications.
Lifestyle changes were documented in 51% of deprescribed cases, most commonly involving dietary changes and physical activity, although documentation in the electronic health record was inconsistent.
Three adverse events were identified during chart review, including one case of hypoglycemia and two cases involving worsening glycemic markers or weight gain; all were determined to be unrelated to deprescribing within the clinical context. No serious adverse events were reported.
The study cohort included patients with a mean age of 67 years among those deprescribed and encompassed 6,052 medication encounters across both practices. A multidisciplinary team reviewed records, and at least two reviewers independently assessed each case to confirm deprescribing events.
The investigators noted several limitations, including the retrospective design, a relatively small number of deprescribed patients for outcome analyses, incomplete documentation of lifestyle interventions, and limited access to broader demographic and disease-duration data. The study design also precluded determination of causality between lifestyle changes and medication reduction.
“[D]eprescribing can be safely and appropriately implemented in routine care and may serve as a valued marker of success for patients and clinicians,” wrote lead study author Yoav Jacob, of Albert Einstein College of Medicine in Bronx, New York, and colleagues.
Several study contributors are affiliated with the American College of Lifestyle Medicine, including employees, members, and research assistants. The study received funding from the Ardmore Institute of Health and the American College of Lifestyle Medicine.
Source: Journal of Clinical Medicine