Pharmacist-led sulfonylurea deprescribing in older adults

Abstract

Background

Sulfonylureas are a high-risk medication in the elderly due to risk of hypoglycemia. Given the continued use of these low-cost medications in elderly patients over recent decades and guideline recommendations for individualized glycosylated hemoglobin (A1c) goals in the elderly, opportunities exist to reduce use in patients with well-controlled diabetes. Hypoglycemia is a costly and potentially deadly adverse effect of inappropriate treatment with sulfonylureas in older adults.

Objectives

To decrease hypoglycemia risk with a clinical pharmacist-led intervention by systematically deprescribing sulfonylureas in a cohort of elderly patients.

Methods

Patients in a managed care setting aged ≥ 80 years with a tightly controlled A1c (≤ 6.5%) and a sulfonylurea pharmacy claim in the previous 120 days were identified as candidates for deprescribing. Medical data were reviewed to determine the clinical appropriateness of sulfonylurea discontinuation for each patient. Physicians were contacted to consider deprescribing based on pertinent clinical characteristics of identified patients, current guideline recommendations, and rationale for deprescribing.

Results

Eighty-nine patients were identified as candidates for discontinuation. Of these, sulfonylurea was discontinued in 41% (n = 37) of patients following pharmacist intervention. Average A1c following intervention remained within generalized guideline goals.

Conclusion

Pharmacist-led interventions can facilitate successful deprescribing by providing systematic guidance, medication therapy expertise, and collaborative decision-making support for physicians.