Scientific Publications Database

Article Title: Deprescribing antihyperglycemic agents in older persons Evidence-based clinical practice guideline
Authors: Farrell, Barbara; Black, Cody; Thompson, Wade; McCarthy, Lisa; Rojas-Fernandez, Carlos; Lochnan, Heather; Shamji, Salima; Upshur, Ross; Bouchard, Manon; Welch, Vivian
Journal: CANADIAN FAMILY PHYSICIAN Volume 63 Issue 11
Date of Publication:2017
Abstract:
Objective To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults.Methods We focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest. We used a rigorous process, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, for guideline development. We conducted a systematic review to assess evidence for the benefits and harms of deprescribing antihyperglycemic agents. We performed a review of reviews of the harms of continued antihyperglycemic medication use, and narrative syntheses of patient preferences and resource implications. We used these syntheses and GRADE quality-of-evidence ratings to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. A decision-support algorithm was developed to accompany the guideline.Recommendations We recommend deprescribing anti-hyperglycemic medications known to contribute to hypo-glycemia in older adults at risk or in situations where antihyperglycemic medications might be causing other adverse effects, and individualizing targets and deprescribing accordingly for those who are frail, have dementia, or have a limited life expectancy.Conclusion This guideline provides practical recommendations for making decisions about deprescribing antihyperglycemic agents. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.