The Development of a Framework to Classify Medication Deprescribing Among Patients with Type 2 Diabetes in Primary...

Background: There is growing recognition that certain medical conditions, such as type 2 diabetes (T2D), can be effectively addressed through comprehensive lifestyle changes, thereby reducing reliance on medications; however, little guidance exists on deprescribing following lifestyle change. This study aimed to develop a framework that can be used to better define and standardize across research studies which medication changes in T2D care can be classified as deprescribing. Methods: An iterative development process began with a review of medication data exported from electronic health records (EHR) for n = 650 patients with T2D, 18-89 years, from two primary care practices with LM board-certified physicians. Included patients were seen during the period of 15 May 2014 to 13 March 2023. All reported T2D medications were grouped into the following categories: insulin, non-insulin, or metformin. A consensus-based review process was employed, facilitated by weekly meetings with the research team, whereby patients were classified as "potentially deprescribed," "not deprescribed," or "unclear" (not enough information based on limited, exported EHR data). Patients identified as potentially deprescribed or "unclear" were then further assessed through a more detailed review of their EHR. Results: Using the results of this chart review, a framework was developed to identify types of deprescribing, as follows: (1) insulin dose reduced; (2) change from insulin to other non-insulin medication; (3) insulin discontinued; (4) non-insulin T2D medication stopped; (5) dose reduced of the same non-insulin T2D medication; (6) change from any non-insulin medication to metformin or multiple medications + metformin to metformin only; (7) metformin stopped; (8) metformin dose reduced. A total of n = 193 patients were identified as having been potentially deprescribed based on the exported EHR data, and after a more detailed review of individual EHR records, 41 were confirmed as deprescribed. Conclusions: This study is the first to present a novel framework for classifying deprescribing in the context of positive health outcomes. The framework will facilitate future research evaluating the impact of lifestyle changes on diabetes management and promote comparability across settings for medication outcomes. Future research is needed to apply this framework to quantify deprescribing across various settings with greater precision.