Medication Deprescribing Protocols for Type 2 Diabetes

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The American College of Lifestyle Medicine (ACLM) has sponsored a qualitative case series research study that provides valuable insights into the protocols that can guide clinical decision-making on medication deprescribing for type 2 diabetes patients. The study, published in Clinical Diabetes, presents the first published examples of protocols that can help clinicians deprescribe medications safely and effectively following successful lifestyle medicine interventions.

The study is of particular importance because intensive therapeutic lifestyle change can lead to significant decreases in blood sugar, which can result in hypoglycemia if prescription medications go unadjusted. Unfortunately, limited guidance and relevant literature often leaves clinicians without adequate resources to help them deprescribe safely and effectively.

Michael Bradley, PharmD, MPH, CDCES, CPH, who was the first author on the paper, said, “The research team was able to document a variety of approaches that exist to successfully deprescribe glucose-lowering medications in a safe and effective way. As the practice of evidence-based lifestyle medicine to treat and attain remission of type 2 diabetes grows, these deprescribing protocols will become increasingly valuable to clinicians who are able to reduce the need for prescription medications and to their patients.”

The study, which was a qualitative case series supported by ACLM, interviewed lifestyle medicine providers who had successfully treated type 2 diabetes with the aim of achieving remission. Key findings included the importance of de-escalating glucose-lowering medications when patients no longer required them, and the need for multidisciplinary teams of allied health professionals to manage deprescribing. It also revealed that medication deprescribing protocols were currently lacking in the field of lifestyle medicine, and called for the development of clinical practice guidelines, educational materials, and more research on the health outcomes of intensive therapeutic lifestyle interventions.

Type 2 diabetes is the seventh leading cause of death in the United States, affecting more than 34.2 million Americans with an estimated cost of $327 billion (about $1,000 per person in the US) in 2017. Lifestyle medicine interventions are an emerging solution to the crisis of type 2 diabetes, with the American Diabetes Association and American Association of Clinical Endocrinology recommending lifestyle optimization as part of medical care for type 2 diabetes.

Read ACLM’s expert consensus statement that reported multi-organizational agreement that dietary changes alone can achieve remission in people with type 2 diabetes.

As ACLM’s Senior Director of Research, Micaela Karlsen, PhD, stated, “While guidelines do not yet exist for medication deprescribing in a lifestyle medicine context, these example protocols may be helpful for other clinicians seeking input on current best practices in deprescribing.”

The authors called for the establishment of clinical practice guidelines and point-of-care tools for medication deprescribing, as well as clinician and patient education materials. The authors also recommended more research on health outcomes resulting from intensive therapeutic lifestyle interventions and comparisons of medication deprescribing practices.

As the sponsor of this research, the American College of Lifestyle Medicine (ACLM) is pleased to provide the first published examples of protocols for medication deprescribing in the context of lifestyle medicine interventions for type 2 diabetes. We recognize that limited literature is available to guide clinicians on deprescribing safely and effectively, and we believe that this study will be a valuable resource for clinicians seeking input on current best practices in deprescribing.

The patient-centered approach of Lifestyle Medicine has been found to be cost-effective and improve the quality of life for individuals with diabetes. Research has indicated that interventions involving whole food, plant-based diets result in greater improvements in glycated hemoglobin (HbA1c) control and quality of life than conventional diet and exercise programs, with increased long-term adherence.

Studies have also revealed that following the Lifestyle Medicine approach can lead to better patient outcomes, as well as the potential for type 2 diabetes remission and reduced reliance on prescription medications, including insulin.

If you are a clinician looking for an evidence-based path toward helping your patients with diabetes regain their health and vitality, we encourage you to register for ACLM’s CME/CE accredited Remission of Type 2 Diabetes and Reversal of Insulin Resistance. Created by exerts with extensive experience in treating type 2 diabetes using both conventional and lifestyle medicine approaches, Remission of Type 2 Diabetes and Reversal of Insulin Resistance will equip you with powerful new approaches to tackle diabetes and insulin resistance.