Deintensifying diabetes medications rarely occurs for older adults with type 2 diabetes (T2D) despite many being tightly controlled with hypoglycemia-inducing medications. We conducted a national survey of US physicians to understand their perspectives on deintensification for older adults with T2D. The survey was designed by a team of patients, caregivers, and physicians, and distributed to a random sample of physicians in general medicine, geriatrics, and endocrinology in three mailing waves. Respondents rated the importance of deintensifying, and of switching to a medication with a better risk/benefit profile, on 5-point Likert scales; the frequency of these actions in the past 3 months; and barriers/facilitators. We received 427 completed surveys to date, response rate 27%. The Figure shows physicians’ responses. Our findings show that the vast majority of US physicians view deintensifying diabetes medications as important to the care of older adults, although they accomplish this infrequently. Major barriers were physicians’ views that patients were reluctant to change medications or to allow their glucose to be higher. Adverse events, especially hypoglycemia, were strong facilitators, as was reducing cost of therapy. Geriatricians reported deintensifying more often than other specialties. Endocrinologists switched medications more often and were more concerned about short-term hyperglycemia.
S.J.Pilla: None. I.J.Wang: None. N.Schoenborn: None. C.Boyd: Other Relationship; Dynamed, UpToDate. S.Golden: Advisory Panel; Abbott Diabetes, Medtronic. N.N.Mathioudakis: None. N.M.Maruthur: Other Relationship; Johns Hopkins HealthCare Solutions.
National Institutes of Health (1R24AG064025 and 1K23DK128572)