Physician perspectives on de-intensifying diabetes medications

• 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
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000005388

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