Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Practice Guideline

. 2017 Nov;63(11):832-843.

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Affiliations

¹ Scientist at the Bruyère Research Institute and C.T. Lamont Primary Health Care Research Centre, Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, and Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario. bfarrell@bruyere.org.
² Research Coordinator at the Bruyère Research Institute.
³ Research Coordinator at the Bruyère Research Institute and a master's candidate in the School of Epidemiology, Public Health and Preventive Medicine at the University of Ottawa.
⁴ Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario and a pharmacy scientist at Women's College Hospital Research Institute.
⁵ Assistant Professor in the School of Pharmacy and the School of Public Health and Health Systems at the University of Waterloo and Schlegel Research Chair in Geriatric Pharmacotherapy at the Schlegel-University of Waterloo Research Institute on Ageing.
⁶ Associate Professor of Medicine at the University of Ottawa and is an endocrinologist at the Ottawa Hospital.
⁷ Assistant Professor in the Department of Family Medicine at the University of Ottawa.
⁸ Professor in the Dalla Lana School of Public Health at the University of Toronto.
⁹ Nurse practitioner with the Bruyère Academic Family Health Team.
¹⁰ Assistant Professor in the School of Epidemiology, Public Health and Preventive Medicine, Deputy Director of the Centre for Global Health at the University of Ottawa, and a clinical epidemiology methodologist at the Bruyère Research Institute.

PMID: 29138153
PMCID: PMC5685444

Practice Guideline

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Barbara Farrell et al. Can Fam Physician. 2017 Nov.

. 2017 Nov;63(11):832-843.

Authors

Affiliations

¹ Scientist at the Bruyère Research Institute and C.T. Lamont Primary Health Care Research Centre, Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, and Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario. bfarrell@bruyere.org.
² Research Coordinator at the Bruyère Research Institute.
³ Research Coordinator at the Bruyère Research Institute and a master's candidate in the School of Epidemiology, Public Health and Preventive Medicine at the University of Ottawa.
⁴ Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario and a pharmacy scientist at Women's College Hospital Research Institute.
⁵ Assistant Professor in the School of Pharmacy and the School of Public Health and Health Systems at the University of Waterloo and Schlegel Research Chair in Geriatric Pharmacotherapy at the Schlegel-University of Waterloo Research Institute on Ageing.
⁶ Associate Professor of Medicine at the University of Ottawa and is an endocrinologist at the Ottawa Hospital.
⁷ Assistant Professor in the Department of Family Medicine at the University of Ottawa.
⁸ Professor in the Dalla Lana School of Public Health at the University of Toronto.
⁹ Nurse practitioner with the Bruyère Academic Family Health Team.
¹⁰ Assistant Professor in the School of Epidemiology, Public Health and Preventive Medicine, Deputy Director of the Centre for Global Health at the University of Ottawa, and a clinical epidemiology methodologist at the Bruyère Research Institute.

PMID: 29138153
PMCID: PMC5685444

Abstract

Objective: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults.

Methods: We focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest. We used a rigorous process, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, for guideline development. We conducted a systematic review to assess evidence for the benefits and harms of deprescribing antihyperglycemic agents. We performed a review of reviews of the harms of continued antihyperglycemic medication use, and narrative syntheses of patient preferences and resource implications. We used these syntheses and GRADE quality-of-evidence ratings to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. A decision-support algorithm was developed to accompany the guideline.

Recommendations: We recommend deprescribing antihyperglycemic medications known to contribute to hypoglycemia in older adults at risk or in situations where antihyperglycemic medications might be causing other adverse effects, and individualizing targets and deprescribing accordingly for those who are frail, have dementia, or have a limited life expectancy.

Conclusion: This guideline provides practical recommendations for making decisions about deprescribing antihyperglycemic agents. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.

PubMed Disclaimer

Figures

**Figure 1.**
Antihyperglycemics Deprescribing Algorithm

See this image and copyright information in PMC

Cited by

Preliminary guidelines for the detection and management of drug-related problems in cancer patients with type 2 diabetes mellitus: a practical resource for oncology pharmacists.
Gossery C, Clarenne J, Barraud S, Brugel M, Boulin M, Carlier C, Perrier M, Botsen D, Hettler D, Kanagaratnam L, Mongaret C, Bouché O, Slimano F. Gossery C, et al. Support Care Cancer. 2024 Nov 14;32(12):791. doi: 10.1007/s00520-024-09014-z. Support Care Cancer. 2024. PMID: 39542931
Designing and validating a clinical decision support algorithm for diabetic nephroprotection in older patients.
Alsalemi N, Sadowski C, Elftouh N, Kilpatrick K, Houle S, Leclerc S, Fernandez N, Lafrance JP. Alsalemi N, et al. BMJ Health Care Inform. 2024 Aug 28;31(1):e100869. doi: 10.1136/bmjhci-2023-100869. BMJ Health Care Inform. 2024. PMID: 39209331 Free PMC article.
Déprescription de la médication contre le diabète chez les personnes âgées fragiles.
Lega IC, Thompson W, McCarthy LM. Lega IC, et al. CMAJ. 2024 Aug 11;196(27):E956-E957. doi: 10.1503/cmaj.231411-f. CMAJ. 2024. PMID: 39134308 Free PMC article. French. No abstract available.
Optimization of type 2 diabetes care in adults aged 65 or older: Practical approach to deintensification.
Bardoczi JB, Aubert CE. Bardoczi JB, et al. Can Fam Physician. 2024 Jun;70(6):391-394. doi: 10.46747/cfp.7006391. Can Fam Physician. 2024. PMID: 38886078 Free PMC article. No abstract available.
Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation.
Stuijt PJC, Heringa M, van Dijk L, Faber A, Burgers JS, Feenstra TL, Taxis K, Denig P. Stuijt PJC, et al. BMC Prim Care. 2024 Jun 11;25(1):210. doi: 10.1186/s12875-024-02465-7. BMC Prim Care. 2024. PMID: 38862899 Free PMC article.

See all "Cited by" articles

References

1. Public Health Agency of Canada . Diabetes in Canada. Facts and figures from a public health perspective. Ottawa, ON: Public Health Agency of Canada; 2011.
1. Pkrl JJ. The demographics of aging.... Transgenerational Design Matters. 2011. Available from: http://transgenerational.org/aging/demographics.htm. Accessed 2017 Jul 5.
1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53. Erratum in: Lancet 1999;354(9178):602. - PubMed
1. ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. Epub 2008 Jun 6. - PubMed
1. Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in older people—a less well recognized risk factor for frailty. Aging Dis. 2015;6(2):156–67. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Public Health Agency of Canada . Diabetes in Canada. Facts and figures from a public health perspective. Ottawa, ON: Public Health Agency of Canada; 2011.

[2] Public Health Agency of Canada . Diabetes in Canada. Facts and figures from a public health perspective. Ottawa, ON: Public Health Agency of Canada; 2011.

[3] Pkrl JJ. The demographics of aging.... Transgenerational Design Matters. 2011. Available from: http://transgenerational.org/aging/demographics.htm. Accessed 2017 Jul 5.

[4] Pkrl JJ. The demographics of aging.... Transgenerational Design Matters. 2011. Available from: http://transgenerational.org/aging/demographics.htm. Accessed 2017 Jul 5.

[5] UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53. Erratum in: Lancet 1999;354(9178):602. - PubMed

[6] UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53. Erratum in: Lancet 1999;354(9178):602. - PubMed

[7] ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. Epub 2008 Jun 6. - PubMed

[8] ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. Epub 2008 Jun 6. - PubMed

[9] Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in older people—a less well recognized risk factor for frailty. Aging Dis. 2015;6(2):156–67. - PMC - PubMed

[10] Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in older people—a less well recognized risk factor for frailty. Aging Dis. 2015;6(2):156–67. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Affiliations

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical