Current Rates of Deprescribing in Type 2 Diabetes

Reframing Deprescribing in Type 2 Diabetes: Beyond Safety, Toward Strategic Optimization

Deprescribing has traditionally been rooted in geriatrics, where the primary focus has been on mitigating hypoglycemia and reducing polypharmacy in older adults with type 2 diabetes. Early efforts emphasized safety in populations with limited life expectancy, frailty, or cognitive impairment. While that lens remains essential, it is increasingly inadequate in today’s landscape of earlier disease onset, rising medication costs, and shifting expectations around chronic disease management. Some clinicians wonder whether current prescribing patterns reflect real long-term patient outcomes. This article explores whether deprescribing in type 2 diabetes patients identifies opportunities beyond safety and outlines early data supporting its feasibility and strategic value.

The First Wave of Deprescribing: Safety-Focused Lessons from Older Adults with Type 2 Diabetes

Most deprescribing research to date has focused on older adults, where the primary goal is to reduce medication-related harms—such as hypoglycemia, falls, and overtreatment—when the risks of continued pharmacologic therapy outweigh the benefits. In these populations, the conversation often centers on life expectancy, frailty, and comorbidities. While this safety-first approach is critical, it leaves important gaps when we look beyond geriatric care.

Two foundational reviews by Seidu et al. (2019) and Oktora et al. (2021) summarize much of the early evidence. Seidu’s systematic review analyzed 10 studies involving 26,558 patients with type 2 diabetes and found deprescribing rates ranging from 13.4% to 75%, with the highest rates in nursing homes and structured care settings. Commonly deprescribed medications included sulfonylureas, insulin, and DPP-4 inhibitors—with no major declines in glycemic control or increases in adverse events.

Oktora’s scoping review expanded on this by analyzing 14 studies (two of which overlapped with Seidu’s), noting deprescribing rates between 14% and 27% when HbA1c was <6.5%. When hypoglycemia was present, rates climbed to 95%—especially when supported by tools like EMR alerts or shared decision-making (Oktora 2021). Both reviews concluded that deprescribing in older adults is feasible and safe, yet underused due to the absence of structured implementation models and real-time decision support.

Recent Studies Support Feasibility—But Highlight Implementation Gaps

More recent observational data reinforce these conclusions. In an integrated care setting, Parker et al. (2024) reported a 38% deprescribing rate among 1,629 older adults, with the highest activity in patients aged ≥85 or those in poor health. Silverii et al. (2020) found that while 62% of elderly patients met criteria for deprescribing, only 22% had actual treatment reductions.

Long-term care settings continue to see higher deprescribing rates. Pan et al. (2023) and Niznik et al. (2020) each observed rates of 45–50% when overtreatment was identified. Similarly, Lederle et al. (2022) found that deprescribing occurred in 27% of overtreated nursing home residents. Across these studies, clinician comfort, patient readiness, and institutional policies strongly influenced deprescribing success.

Limitations of the Current Evidence Base

Despite promising findings, both Seidu and Oktora highlighted several limitations in the deprescribing literature:

  • Lack of standardization: Definitions of deprescribing, outcome measures, and patient criteria varied widely, making comparison and generalization difficult.
  • Small, observational studies: Most studies lacked control groups, long-term follow-up, and patient-centered outcomes like satisfaction, function, or quality of life.
  • Limited subgroup analysis: Few studies stratified by frailty, comorbidity burden, or life expectancy—despite these factors being essential to real-world decision-making.

Recent studies by Parker, Silverii, Niznik, Lederle, and Pan echoed these limitations. Most were retrospective, health system–specific, and reliant on administrative data that didn’t fully capture shared decision-making or patient context. Even when overtreatment was flagged, deprescribing remained uncommon, with minimal attention to cognitive or social drivers of care.

The Second Wave: Deprescribing as a Marker of Treatment Success

While safety remains foundational, a second wave of deprescribing is emerging—one that reframes medication reduction as a marker of disease reversal rather than just harm avoidance. Here, lifestyle interventions become the driving force. This evolving view positions deprescribing as a proactive, value-based strategy—especially in patients who regain metabolic control through intensive non-pharmacologic means. Despite growing evidence for the effectiveness of lifestyle interventions in type 2 diabetes, traditional care models rarely treat deprescribing as a clinical goal. Concerns around long-term sustainability, liability, and reimbursement often deter clinicians. However, a small but growing body of research is now challenging this hesitation and framing deprescribing as a legitimate, outcomes-driven target.

Two Key Studies Show It Can Be Done

To date, only two studies have directly evaluated deprescribing in patients with type 2 diabetes actively engaged in lifestyle-based treatment. One (McKenzie et al. 2024) explicitly used the term “deprescribing,” while the other (Hallberg et al. 2018) remains one of the most comprehensive investigations into structured lifestyle care with medication reduction as a measured outcome.

  • McKenzie et al. (2024): Deprescribing GLP-1s with Carbohydrate-Restricted Therapy: McKenzie et al. assessed outcomes following GLP-1 deprescribing in 154 adults using carbohydrate-restricted nutritional therapy (CRNT) via a telemedicine platform, comparing them to a matched group that continued GLP-1 use. At 12 months, 64.8% of the deprescribed (DeRx) group and 64.1% of the continued therapy (Rx) group maintained HbA1c below 6.5%. Normoglycemia (HbA1c <5.7%) was also comparable: 20.4% in the DeRx group vs. 20.3% in the Rx group. These results suggest that CRNT can sustain glycemic outcomes even after withdrawal of one of the most potent medication classes in diabetes care.
  • Hallberg et al. (2018): Structured Lifestyle Intervention With Comprehensive Deprescribing: Hallberg’s study evaluated a 349-patient cohort participating in a remote care program that included low-carbohydrate nutrition, continuous monitoring, and active medication management. Over one year, diabetes medication use (excluding metformin) dropped from 56.9% to 29.7% (P < 1.0 × 10⁻¹⁶) (a 48% reduction). Insulin was reduced or eliminated in 94% of users, and sulfonylureas were entirely deprescribed. Among those on insulin at baseline, 40% discontinued it entirely, while others reduced their dose by half. Substantial reductions in DPP-4 and SGLT2 use were also observed, with GLP-1 use remaining stable. The protocolized approach demonstrates the feasibility of safe, large-scale deprescribing in the context of high-touch, lifestyle-driven care.

What These Studies Offer

Both Hallberg and McKenzie offer important early signals that deprescribing in type 2 diabetes is not only possible—it can be clinically effective when paired with targeted lifestyle support. These studies share several strengths:

  • Real-world relevance: Both were conducted in outpatient, free-living populations, not just controlled lab settings.
  • Inclusion of complex patients: Participants often had longstanding diabetes, a group often excluded from clinical trials.
  • Design strengths: Hallberg’s prospective design and high retention bolster validity; McKenzie’s matched cohort design improves comparability in an observational setting.

Remaining Gaps and Future Directions

Yet limitations persist. Neither study was randomized, reducing the ability to infer causality. Both lacked racial and ethnic diversity, limiting generalizability. Data on socioeconomic, psychosocial, or genetic factors were absent. Importantly, neither trial was powered to assess long-term outcomes like mortality or hospitalization. Design differences also affect applicability. Hallberg’s was a single-site trial with structured monitoring and broader deprescribing across drug classes. McKenzie’s study focused specifically on GLP-1 withdrawal and could not account for prior medication exposure or variability in diet adherence across the nationwide sample.

Still, both studies move the needle. They show that deprescribing in patients with type 2 diabetes is not only safe—it can be used as a measurable clinical outcome when lifestyle interventions are structured, supported, and intentional.

Key Takeaways:

As deprescribing gains momentum, it’s becoming clear that this isn’t just a geriatrics issue—it’s a strategic opportunity across all of type 2 diabetes care. Clinicians and decision-makers now have growing evidence to support deprescribing not only as a marker of safety but also as an indicator of lifestyle success and care model efficiency.

  • Deprescribing in older adults is well-established, with over 20 studies reporting rates between 13% and 75%—highest in structured care settings like nursing homes or integrated systems.
  • Lifestyle-driven deprescribing is emerging as a viable option in younger populations, with one major study showing a 48% reduction in diabetes medications and even higher rates in specific drug classes.
  • Structured interventions enable success, especially when paired with protocols, shared decision-making, telemedicine, and real-time biomarker tracking.
  • Evidence is promising but still maturing, with current gaps in standardization, diversity, and long-term outcomes that limit scalability and payer adoption.
  • The business case is growing—for clinical consultants and lifestyle-focused clinicians, the ability to execute and quantify deprescribing’s clinical, financial, and operational impact may be key to unlocking broader adoption and patient outcomes.

References:

  1. Seidu, Samuel, et al. ‘Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes.’ Diabetes, Obesity and Metabolism 21.7 (2019): 1668-1679.
  2. Oktora, M. P., et al. ‘Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: a scoping review.’ Diabetic Medicine 38.2 (2021): e14408.
  3. Parker, Melissa M., et al. ‘Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients’ Perspectives: The Diabetes and Aging Study.’ Journal of the American Geriatrics Society (2024).
  4. Silverii, Giovanni Antonio, et al. ‘Deprescription in elderly patients with type 2 diabetes mellitus.’ diabetes research and clinical practice 170 (2020): 108498.
  5. Pan, Jeffrey, et al. “Rates of overtreatment and deprescribing of antihyperglycemics among long-term care residents in British Columbia.” Journal of the American Geriatrics Society 71.8 (2023): 2657-2661.
  6. Niznik, Joshua D., et al. “Deintensification of diabetes medications among veterans at the end of life in VA nursing homes.” Journal of the American Geriatrics Society 68.4 (2020): 736-745.
  7. Lederle, Lauren I., et al. “Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.” Journal of the American Geriatrics Society 70.7 (2022): 2019-2028.
  8. McKenzie, Amy L., and Shaminie J. Athinarayanan. “Impact of glucagon-like peptide 1 agonist deprescription in type 2 diabetes in a real-world setting: a propensity score matched cohort study.” Diabetes Therapy 15.4 (2024): 843-853.
  9. Hallberg SJ, McKenzie AL, Williams P, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at One Year: An Open Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018. DOI: 10.1007/s13300-018-0373-9. Medication and weight-loss is for people living with type 2 diabetes and completing 1 year. Medication reduction refers to the percent of total diabetes prescriptions eliminated, excluding metformin.

Reframing Deprescribing in Type 2 Diabetes: Beyond Safety, Toward Strategic Optimization

  • Address: 123 Main Street, New York, NY 10001
  • Hours: Mon-Fri 9:00AM – 5:00PM
  • Phone: 123-456-7890
  • Email: contact@mysite.com
Scroll to Top