A National Survey of Physicians’ Views on the Importance and Implementation of Deintensifying Diabetes Medications

• Published in: Journal of general internal medicine : JGIM 2024-05, Vol.39 (6), p.992-1001
• Main Authors: Pilla, Scott J., Jalalzai, Rabia, Tang, Olive, Schoenborn, Nancy L., Boyd, Cynthia M., Bancks, Michael P., Mathioudakis, Nestoras N., Maruthur, Nisa M.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Aged; Attitude of Health Personnel; Decision making; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Endocrinology; Female; Geriatrics; Glycated Hemoglobin - analysis; Hemoglobin; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Older people; Original Research; Patients; Physicians; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Regression analysis; Regression models; Surveys; Surveys and Questionnaires; Switching; United States
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-023-08506-8

Background Guidelines recommend deintensifying hypoglycemia-causing medications for older adults with diabetes whose hemoglobin A1c is below their individualized target, but this rarely occurs in practice. Objective To understand physicians’ decision-making around deintensifying diabetes treatment. Design National physician survey. Participants US physicians in general medicine, geriatrics, or endocrinology providing outpatient diabetes care. Main Measures Physicians rated the importance of deintensifying diabetes medications for older adults with type 2 diabetes, and of switching medication classes, on 5-point Likert scales. They reported the frequency of these actions for their patients, and listed important barriers and facilitators. We evaluated the independent association between physicians’ professional and practice characteristics and the importance of deintensifying and switching diabetes medications using multivariable ordered logistic regression models. Key Results There were 445 eligible respondents (response rate 37.5%). The majority of physicians viewed deintensifying (80%) and switching (92%) diabetes medications as important or very important to the care of older adults. Despite this, one-third of physicians reported deintensifying diabetes medications rarely or never. While most physicians recognized multiple reasons to deintensify, two-thirds of physicians reported barriers of short-term hyperglycemia and patient reluctance to change medications or allow higher glucose levels. In multivariable models, geriatricians rated deintensification as more important compared to other specialties ( p =0.027), and endocrinologists rated switching as more important compared to other specialties ( p