TABLE 4.
Recommended Medication Deprescribing Interventions
| Lifestyle Medicine Practitioner | Medication Classes and Deprescribing Prioritization |
|---|---|
| M.M.M. | First priority: SFU and insulin; second priority: TZD; third priority: DPP-4 inhibitor; fourth priority: SGLT2 inhibitor, GLP-1 receptor agonists,* and metformin. Insulin deprescribing is individualized and based on clinical judgment. |
| J.H.K. | First priority: SFU, insulin secretagogues, and insulin. Almost always deprescribes long-acting insulin. Metformin remains if fasting serum glucose is >100 mg/dL, patient tolerates it, and renal function is good. Deprescribing is individualized to the patient and medication profile. |
| G.E.G. | First priority: SFU and any medication causing hypoglycemia; second priority: TZD. DPP-4 inhibitors are stopped early because of low cost/benefit profile. Continues GLP-1 receptor agonists until HOMA2-β† normalizes, and continues metformin until HOMA-IR normalizes. Deprescribing is patient-specific. |
| C.T. | First priority: medications that cause hypoglycemia (i.e., SFU and insulin); second priority: blood pressure medications. Deprescribing is patient-specific. Shared decision-making is key. |
| B.G.B. | First priority: metformin; second priority: insulin. Considers cost to patient. Deprescribing is patient-specific. |
| J.F. | First priority: SFU; second priority: insulin. |
| S.L. | Nonspecific, no priority; will deprescribe all oral medications except metformin. For insulin, reduces dose by 10–20%. |
| J.F.L. | First priority: SFU and other oral hypoglycemic medications; second priority: statins (primary prevention use only). Deprescribes other medications based on cost. Metformin is deprescribed last. Change in short-acting insulin is individualized per patient need. |
| T.M.C. | First priority: SFU (if patient is prescribed a high dose, will taper dose by 50% and then assess) and insulin (as appropriate); second priority: TZD and DPP-4 inhibitor (based on glucose control and adverse effects). SGLT2 inhibitor, GLP-1 receptor agonist, and metformin are last for deprescribing consideration. |
*
Less likely to deprescribe GLP-1 receptor agonists in patients with CKD and/or ASCVD. Comfortable with continuing a GLP-1 receptor agonist if the patient is tolerating it and has obesity.
†
HOMA2-β is a validated mathematical tool commonly used to estimate β-cell function in type 2 diabetes using fasting glucose and insulin (48).