Medicines to lower glucose have dramatically improved the lives of patients with type 2 diabetes. However, these powerful medicines can also have negative consequences, specifically hypoglycemia, which has been found in older individuals who have car accidents, hip fractures, cardiac arrhythmias, worsening cognitive function, worsening quality of life, and increased mortality risk. For most patients, these adverse events are rare and the benefits of treatment more than offset them; however, as patients age, become frail, and have limited life expectancy, the balance of benefits versus harms begins to shift. With more than one-quarter of adults over age 65 now diagnosed with diabetes, including 4 million US adults over age 75, the question of whether to reduce treatment intensity (i.e., medication deprescribing) has been increasingly recognized as a critical decisional dilemma. Understanding how and when to reduce therapy represents an important gap in the current evidence that affects the health of millions of older US adults with diabetes.
Making an informed health choice about medication deprescribing requires an understanding of the relevant trade-offs by both patients and providers. We will test two strategies to improve safe deprescribing:
- academic detailing (a pragmatic educational intervention directed toward doctors); and
- academic detailing with the addition of patient pre-visit preparation (a strategy that more directly involves patients in preparing for and participating in deprescribing decision-making discussions). Our proposal is designed to fill this evidence gap by evaluating two proven strategies for facilitating collaborative decision making.
Other Health Services Interventions
Training and Education Interventions