May 22, 2026

What new research says about deprescribing T2D medications after lifestyle change

By Alex Branch Director of Communications

By Alex Branch Director of Communications

As evidence grows that lifestyle interventions can improve glycemic control–and in some cases achieve remission–in type 2 diabetes, clinicians face a critical but underexamined challenge: how and when to safely reduce glucose‑lowering medications. Three recent ACLM‑led studies provide complementary real‑world evidence, clinician perspectives, and a shared research framework to help guide thoughtful deprescribing in routine care.

Type 2 diabetes (T2D) has traditionally been understood as a steadily progressive condition, treated by adding medications over time as glycemic control worsens. However, research increasingly shows that evidence-based lifestyle interventions can substantially improve glycemia and, for some individuals, lead to remission. 

As this evidence base grows, a critical clinical gap has become more apparent: when glycemic control improves through lifestyle change, how do clinicians approach the safe reduction or discontinuation of glucose-lowering medications, and how closely do their approaches align with formal recommendations? 

Three recent ACLM-led, peer‑reviewed studies help address this question in complementary ways. Together, they offer real-world data, practice‑based insights, and a shared research framework to inform how lifestyle‑associated improvements in glycemic control can translate into thoughtful, patient-centered deprescribing.

Building the deprescribing framework  

The first paper, published in the Journal of Clinical Medicine, laid the methodological groundwork needed to study deprescribing more systematically. It introduced and refined a framework for identifying, classifying, and analyzing deprescribing events in patients with T2D following lifestyle change, particularly within primary care settings. 

By establishing shared definitions and categories for deprescribing events, the framework enables future research to compare outcomes across settings, evaluate safety more rigorously, and eventually inform clinical guidance. It also recognizes an important gap in deprescribing literature: most existing frameworks focus on polypharmacy in older adults, adverse effects, or end-of-life care, rather than health improvement as a trigger for medication reduction. 

Real‑world evidence of deprescribing in primary care 

The second paper, a retrospective chart review published in the Journal of Clinical Medicine, used this framework to examine electronic health records from 650 adults with T2D receiving care in two primary care practices that integrate lifestyle medicine into routine visits (not intensive lifestyle programs or specialty clinics). Researchers identified 41 confirmed cases (6.3%) in which diabetes medications were reduced or discontinued following improvements in clinical markers such as weight and blood glucose. 

Several findings are especially relevant for clinicians: 

• Deprescribing occurred organically during routine primary care, rather than through a formal medication reduction protocol 
• Among patients with follow-up data, mean BMI decreased by 2.2 kg/m and mean blood glucose dropped by 50.5 mg/dL–both statistically significant 
• No serious adverse events attributable to deprescribing were identified  

While a finding of 6.3% confirmed cases in which diabetes medications were reduced may appear modest, the clinical significance is substantial. These patients were not selected for intensive lifestyle treatment, and many were not explicitly seeking lifestyle-focused care. If similar outcomes were replicated nationally among the 38 million Americans living with type 2 diabetes, even this deprescribing rate could translate into millions of patients reducing medication burden, lowering treatment costs, and decreasing risk of medication-related side effects.  

How lifestyle medicine clinicians are already deprescribing  

The third paper, published in the American Journal of Lifestyle Medicine, surveyed 67 lifestyle medicine clinicians with prescriptive authority to better understand how deprescribing decisions are being made in real-world practice.  

More than half of the clinicians surveyed reported having no formal deprescribing protocol at the time the survey was done, yet most described systematic, patient-centered approaches guided by glucose monitoring, medication risk profiles, and patient response to lifestyle change. Medications associated with higher hypoglycemia risk, such as sulfonylureas and mealtime insulin, were typically reduced first, while metformin was often tapered later or maintained longer. Overall, these practices are consistent with recommendations from ACLM’s “Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine” Key Action Statement #14: Adjusting pharmacologic therapy.

Notably, clinicians reported that clinically significant hypoglycemia during lifestyle-driven deprescribing was “rare” or “uncommon.” Monitoring practices frequently involved blood testing of A1c, fasting glucose, and lipid panels, and–when accessible–continuous glucose monitoring devices. 

Clinical implications 

Taken together, these studies advance understanding of deprescribing in several ways: 

• Demonstrate that lifestyle-driven deprescribing is feasible and safe for a subset of patients with T2D, even in routine primary care 
• Show that clinicians are already deprescribing thoughtfully–aligning with best practices as recommended in clinical practice guidelines 
• Reposition deprescribing as a positive clinical outcome, reflecting improved metabolic health and reduced treatment burden.  

For clinicians, these findings reinforce the importance of reassessing medication needs as metabolic health improves through lifestyle change. Deprescribing, when individualized and carefully monitored, can be a safe and meaningful part of high‑quality type 2 diabetes care.