Physician perspectives on de-intensifying diabetes medications

Guidelines for diabetes care recommend that physicians select individualized glycemic goals based on life expectancy, diabetes duration, comorbidity, and resources/support. When patients have stable hemoglobin A1C (HbA1C) levels, guidelines lack recommendations on when diabetes medications should be...

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Bibliographic Details
Published in:Medicine (Baltimore) 2016-11, Vol.95 (46), p.e5388-e5388
Main Authors: Genere, Natalia, Sargis, Robert M., Masi, Christopher M., Nathan, Aviva G., Quinn, Michael T., Huang, Elbert S., Laiteerapong, Neda
Format: Article
Language:English
Subjects:
Attitude of Health Personnel
Clinical Decision-Making - methods
Cross-Sectional Studies
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - psychology
Drug Monitoring - methods
Female
Glycated Hemoglobin - analysis
Humans
Hypoglycemic Agents - therapeutic use
Male
Middle Aged
Observational Study
Patient Care Planning - standards
Patient Preference - psychology
Patient Preference - statistics & numerical data
Physician-Patient Relations
Physicians - psychology
Physicians - statistics & numerical data
Practice Guidelines as Topic
Quality Improvement
United States
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Summary:Guidelines for diabetes care recommend that physicians select individualized glycemic goals based on life expectancy, diabetes duration, comorbidity, and resources/support. When patients have stable hemoglobin A1C (HbA1C) levels, guidelines lack recommendations on when diabetes medications should be de-intensified.To understand physicians' perspectives on de-intensifying diabetes medications in patients with type 2 diabetes.Cross-sectional survey, (February-June, 2015).Academic medical center and suburban integrated health system.Primary care and endocrinology physicians.Physicians' self-reported: awareness, agreement, and frequency of individualizing HbA1C goals; practice of de-intensifying diabetes medications; HbA1C values at which physicians de-intensify diabetes medications; and other patient factors physicians consider when de-intensifying diabetes medications.Response rate was 73% (156/213). Most physicians (78%) responded they were familiar with recommendations to individualize HbA1C goals. For patients with stable HbA1C levels, 80% of physicians reported they had initiated conversations about stopping medications; however, physicians differed in predefined HbA1C levels used to initiate conversations (HbA1C 
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000005388