Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Medicines to treat type 2 diabetes can improve peoples’ lives by controlling blood sugar and preventing health problems. But as people age, the harms of these medicines may outweigh the benefits. For example, one common side effect of diabetes medicines, low blood sugar, increases the risk of heart problems, car accidents, and death in older adults. Clinicians, such as doctors and nurse practitioners, can help patients decide whether to reduce or change their diabetes medicines as they age.

In this study, the research team is comparing two ways to help clinicians and older patients talk about the benefits and harms of diabetes medicines. The team is looking at how well these approaches work to reduce the amount of diabetes medicines older patients take. Also, the team wants to know how well these approaches prevent low blood sugar.

Who can this research help?

Results may help clinics considering ways to help manage treatment for type 2 diabetes among older patients.

What is the research team doing?

The research team is recruiting 440 patients in northern California who are at least 75 years old and taking medicine to manage type 2 diabetes.

All clinicians in the study are receiving two educational sessions about prescribing diabetes medicines. The sessions are held six months apart. Then the research team is assigning patients by chance to one of two groups:

  • Discussion aid. Patients in this group receive a one-page discussion aid before their visit with the doctor. The aid provides information about the benefits and harms of diabetes treatment as patients age. The aid also helps patients think about their preferences for diabetes treatment and provides tips on how to talk to their doctor.
  • General handout. Patients in this group receive a general health education handout. The handout provides general advice for older patients on topics such as eating healthy and staying active.

The research team is looking at patients’ health records six months after their doctor’s visit to see how much medicine patients took and how often they went to the hospital for low blood sugar. Also, patients are completing surveys that ask

  • If they had any episodes of low blood sugar
  • What their blood sugar levels were
  • How satisfied they were with their diabetes treatment
  • How confident they felt when talking to their doctor

To learn how patients and clinicians make decisions, the research team is listening to audio recordings of select clinic visits.

Patients, clinicians, and pharmacists are helping to plan and conduct this study.

Research methods at a glance

Design Element Description
Design Randomized controlled trial
Population 440 adults at least 75 years of age with type 2 diabetes
  • Academic detailing for providers plus conversation aid for patients
  • Academic detailing for providers plus general educational handout for patients

Primary: diabetes medication deprescribing (discontinuation of diabetes medication, dose reduction, or changing medication from a high-risk to a low-risk medication); self-reported hypoglycemia

Secondary: hypoglycemic-related hospitalizations, change in HbA1c level, patient-reported diabetes treatment satisfaction, patient satisfaction, and perceived efficacy in patient-physician interactions

Timeframe 6-month follow-up for primary outcome

Project Information

Richard W. Grant, MD, MPH
Kaiser Foundation Hospitals
Reducing Treatment Risk in Older Patients with Diabetes: Comparative Effectiveness of Academic Detailing with and without Pre-Visit Patient Preparation

Key Dates

November 2019
May 2025

Study Registration Information


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 28, 2024