Cristina García-Ulloa A, Jaime-Casas S, Rosado-Lozoya J, Serrano-Pérez NH, Hernández-Juárez D, Luis Cárdenas-Fragoso J, Eduardo Briones-García L, Jiménez-Soto R, García-Padilla C, García-Lara J, Aguilar-Salinas CA, Hernández-Jiménez S. De-escalating treatment indications for patients who achieve metabolic goals.
Diabetes Res Clin Pract 2024;
208:111096. [PMID:
38244782 DOI:
10.1016/j.diabres.2024.111096]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION
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.
OBJECTIVE
To encompass current recommendations for deprescribing common drugs and create a consensus among health professionals.
METHODS
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).
RESULTS
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.
CONCLUSION
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.
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