De-escalating treatment indications for patients who achieve metabolic goals

Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects. To encompass current r...

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Published in:Diabetes research and clinical practice 2024-02, Vol.208, p.111096-111096, Article 111096
Main Authors: Cristina García-Ulloa, Ana, Jaime-Casas, Salvador, Rosado-Lozoya, Johanna, Serrano-Pérez, Nancy H., Hernández-Juárez, Diana, Luis Cárdenas-Fragoso, José, Eduardo Briones-García, Luis, Jiménez-Soto, Rodolfo, García-Padilla, Carlos, García-Lara, Juan, Aguilar-Salinas, Carlos A., Hernández-Jiménez, Sergio
Format: Article
Language:English
Subjects:
De-escalating
De-intensification
Diabetes
Dyslipidemia
Metabolic control
Uric acid
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Summary:Robust evidence exists regarding initiation, intensification or modification of treatments. Recommendations to de-escalate therapy are lacking, specifically in diabetes. A successful treatment de-intensification reduces overtreatment, polypharmacy, and risk of adverse effects. To encompass current recommendations for deprescribing common drugs and create a consensus among health professionals. We reviewed four databases for deprescribing approaches published between 2010 and 2022. Articles were divided into different groups of drugs (for uric-acid, hypoglycemic, lipid-lowering, and psychotropic drugs). Hypoglycemic agents: strategies were limited to newer agents and insulin regimens for elderly individuals. Reducing insulin was associated with 1.1% reduction of A1c over time. SGLT2i and GLP-1RAs dose reduction depends on adverse events. Lipid-lowering agents: studies show that patients with very low cholesterol have fewer cardiovascular events without associated increased risk. Antihypertensive agents: Younger patients, lower systolic blood pressure, and few comorbidities are ideal characteristics for discontinuation. Uric acid therapy: we found no recommendation for dose de-escalation. Poor treatment adherence is associated with episodes of gout and deforming arthritis in the long term. Deprescribing hypoglycemic, statins, antihypertensives, and urate-lowering agents may be feasible in selected patients, but periodic surveillance is important. More evidence is necessary to support this decision entirely.
ISSN:0168-8227
1872-8227
DOI:10.1016/j.diabres.2024.111096