Academic detailing increased deprescribing of diabetes meds in older patients
For older diabetes patients at risk of treatment-related hypoglycemia, receiving a brochure and having their physicians participate in a virtual academic detailing presentation resulted in the highest rate of medication deprescribing.
Academic detailing sessions for physicians and handouts for patients increased deprescribing among older patients taking diabetes medications that pose a risk of hypoglycemia, a study found.
Researchers conducted a randomized clinical trial involving 211 primary care physicians and 450 patients to assess whether physician academic detailing in the form of a 45-minute virtual presentation, with or without patient previsit activation in the form of an educational handout given before a visit, led to deprescribing of insulin and/or sulfonylureas in older patients with type 2 diabetes. Primary outcomes were deprescribing of these medications and any patient-reported episodes of severe hypoglycemia. Results appeared June 23 in JAMA Internal Medicine.
The randomized clinical trial ran from September 2020 to March 2024 in a large integrated health care system in California. Primary care physicians and their patients with type 2 diabetes who were 75 years and older, had HbA1c level of 8.0% or lower, and were treated with insulin and/or sulfonylureas were included. Participating physicians attended at least one academic detailing session that provided evidence to support diabetes medication reassessment and potential deprescribing. Trial patients were randomly assigned before their visit to receive either the previsit handout (academic detailing plus previsit arm) or an attention control healthy lifestyle handout (academic detailing-only arm).
At six months, the targeting medications had been discontinued at a higher rate in the academic detailing plus previsit activation arm compared with the academic detailing-only arm (36 of 232 patients [15.8%] vs. 19 of 218 patients [9.0%]; adjusted risk difference [RD], 7.5% [95% CI, 1.5% to 13.6%; P=0.01). This difference persisted at 12 months (50 of 232 patients [22.8%] vs. 33 of 218 patients [16.3%]; adjusted RD, 7.9% [95% CI, 0.4% to 15.5%]; P=0.04). There was not a statistically significant difference in hypoglycemia episodes at six months (10 of 232 patients [4.7%] vs. 13 of 218 patients [6.5%], respectively; adjusted RD, −2.3%; 95% CI, −7.1% to 2.5%; P=0.04).
The study's results underscore the value of involving both patients and physicians in any efforts to make meaningful changes to diabetes care plans, wrote the authors, who added that a simple previsit handout augmented the impact of academic detailing education that focused on safe diabetes medication deprescribing.
“[Academic detailing] AD is low cost, relatively easy to implement, and has had a positive effect on physician deprescribing practices,” the authors wrote. “However, alone, this strategy to address medication management is limited by the lack of direct patient involvement in the decision-making process. Results of this study provide rigorous randomized trial data supporting the value of engaging patients prior to their primary care visits to augment AD.”