Deprescribing sulfonylureas in patients over the age of 65 within the Boise VA Medical Center

Background

There are hypoglycemia-related safety concerns with sulfonylureas, especially in older adults with type 2 diabetes mellitus (T2DM). Clinical pharmacist practitioners working in primary care clinics have the opportunity to address these concerns and potentially optimize patients’ diabetes medication regimens through deprescribing of potentially unsafe sulfonylureas.

Objective

This study aimed to assess the impact of a pharmacist-led sulfonylurea deprescribing campaign in older adults with T2DM in the primary care setting of a Veterans Affairs medical center.

Methods

This was a prospective sulfonylurea deprescribing campaign conducted over a period of approximately 5 months at a single institution. Patients were enrolled if they were older than 65 years with an active sulfonylurea prescription, had an A1c of less than 8%, and were on select primary care teams. The primary project evaluator telephoned eligible patients to invite them to participate in a sulfonylurea deprescribing initiative, with those accepting then receiving a scheduled call to deprescribe their therapy and at least 1 subsequent follow-up call to assess changes in blood glucose. The primary end point was the percentage of patients successfully deprescribed from sulfonylurea therapy. Secondary end points were the number of patients requiring diabetes therapy adjustment and the number of follow-up visits required to optimize antidiabetic medications after sulfonylurea discontinuation.

Results

Nineteen patients received the sulfonylurea deprescribing intervention. Of these patients, 11 were able to successfully discontinue therapy with 3 of these patients requiring additional antidiabetic medication adjustments. Nine patients who received the intervention needed only 1 follow-up visit. At the time of data collection, 4 patients were still undergoing therapy adjustments after their initial sulfonylurea discontinuation.

Conclusion

This pharmacist-led sulfonylurea deprescribing campaign was successful. However, it did require substantial pharmacist involvement with some patients needing extended follow-up.