European Journal of Cardiovascular Medicine

Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder characterized by insulin resistance and β-cell dysfunction. It is associated with significant morbidity and mortality, primarily due to cardiovascular complications, kidney disease, and other comorbidities. The management of T2DM often involves polypharmacy, which increases the risk of adverse drug events, drug-drug interactions, and medication non-adherence [1,2].

Polypharmacy, defined as the concurrent use of multiple medications, is common among older adults with T2DM due to the presence of comorbid conditions such as hypertension, dyslipidemia, and cardiovascular disease [3]. The use of multiple medications can lead to a higher incidence of adverse drug reactions, including hypoglycemia, especially when medications are not appropriately adjusted to the patient's current health status [4].

Medication deprescribing, the process of tapering or stopping medications that are no longer beneficial or may be causing harm, has gained attention as a strategy to mitigate the risks associated with polypharmacy [5]. In the context of T2DM, deprescribing aims to reduce the burden of unnecessary medications, minimize adverse effects, and improve patient outcomes [6].

Several studies have explored the feasibility and safety of deprescribing in older adults with T2DM. For instance, a randomized clinical trial demonstrated that deprescribing antidiabetic medications in older adults led to a reduction in the risk of hypoglycemia without adversely affecting glycemic control [7]. Another study highlighted the role of pharmacist-led deprescribing interventions in reducing medication-related harm in elderly patients with T2DM [8].

Despite the potential benefits, deprescribing remains underutilized in clinical practice. Barriers to its implementation include healthcare provider reluctance, patient concerns about stopping medications, and lack of structured protocols [9]. Addressing these barriers requires a multifaceted approach, including education, patient engagement, and the development of clear deprescribing guidelines [10].

This study aims to evaluate the prevalence, patterns, and outcomes of medication deprescribing among patients with T2DM. By examining the impact of deprescribing on medication adherence, glycemic control, and patient-reported outcomes, this research seeks to provide evidence to inform clinical practice and enhance the quality of care for individuals with T2DM.

Study design: Observational prospective study design.

Place of study: Medicare Multi Speciality Hospital.

Period of study: The study was conducted for 6 months.

Study Variables:

• Age
• Gender
• Duration of diabetes
• Comorbidities
• Medications
• Dietary Adherence
• Life Style
• Outcome

Sample size:200 patients with Type-2 diabetes.

Inclusion Criteria:

• Patients diagnosed with type 2 Diabetes Mellitus irrespective of the co-morbidities present.
• Patients of age above 18 years irrespective of their gender.

Exclusion Criteria:

• Patients with type 1 Diabetes.
• Gestational Diabetes Mellitus.

Statistical Analysis: Data collected from 200 patients with type 2 diabetes mellitus were entered and analyzed using SPSS version 25.0. Descriptive statistics, including mean ± standard deviation for continuous variables and frequency with percentages for categorical variables, were calculated to summarize demographic characteristics, comorbidities, medication patterns, lifestyle factors, dietary adherence, and treatment outcomes. Comparative analyses were performed using the chi-square test or Fisher’s exact test for categorical variables and independent t-test or ANOVA for continuous variables, where appropriate. A p-value of <0.05 was considered statistically significant. The analysis aimed to evaluate patterns of medication deprescribing, adherence, lifestyle factors, and their association with treatment outcomes.

Table 1: Demographic and Clinical Characteristics of Patients with Type 2 Diabetes Mellitus (n = 200)

Table 2: Medications De-prescribed During the Study

Table 3: Family History and Medication Compliance of Study Participants

Table 4: Social History and Comorbidities of Study Participants

Table 5: Dietary Adherence among Study Participants (n = 200)

Table 6: Life style Habits

Table 7: Outcomes of Deprescribing Interventions Among Patients

Figure 1: Baseline characteristics of study subjects (n=15)

Figure 2: Complications occurred during therapy

The study included a total of 200 patients with type 2 diabetes mellitus, with a mean age of 54.3 ± 11.3 years. Females constituted 61.5% (n = 123) of the study population, while males accounted for 38.5% (n = 77). The mean duration of diabetes among participants was 8.6 ± 5.76 years. Regarding comorbidities, hypertension was the most common, affecting 48% (n = 96) of patients, followed by hypothyroidism in 16% (n = 32), dyslipidemia in 7% (n = 14), and cardiovascular disease in 5% (n = 10). Other comorbid conditions included stroke (2%, n = 4), obesity (2%, n = 4), and a range of other illnesses in 19% (n = 38) of participants.

Among the 65 patients who underwent medication review, various antidiabetic drugs were deprescribed either completely or partially. Sulfonylureas were completely deprescribed in 31.8% of patients and partially deprescribed in 32.6%. Insulin showed a complete deprescribing rate of 34.1% and partial deprescribing in 16.3% of patients. Dipeptidyl peptidase-4 (DPP-4) inhibitors were completely deprescribed in 18.2% and partially in 27.9% of cases, while biguanides were completely deprescribed in 15.9% and partially in 25.6% of patients. Alpha-glucosidase inhibitors were completely deprescribed in 13.6%, with no cases of partial deprescribing. Thiazolidinediones were completely deprescribed in 9.1% and partially in 4.7% of patients. Sodium-glucose cotransporter-2 (SGLT2) inhibitors were completely deprescribed in 6.8% and partially in 9.3%, whereas other antidiabetic medications were completely deprescribed in 4.5% and partially in 7% of patients.

Among the study population, 28% (n = 56) of patients reported a positive family history of diabetes, while 72% (n = 144) had no known family history. Regarding medication adherence, 22% (n = 44) of patients were non-compliant with their prescribed therapy, whereas 68.5% (n = 137) reported regular compliance. Additionally, 9.5% (n = 19) of participants were classified as highly non-compliant.

Analysis of social history revealed that 4.5% (n = 9) of patients were regular alcohol consumers, while 20.5% (n = 41) reported occasional alcohol intake. Smoking was observed in 1.5% (n = 3) of the study population, whereas the majority, 73.5% (n = 147), had no notable habits. Regarding comorbidities, hypertension was the most prevalent, affecting 48% (n = 107) of patients, followed by hypothyroidism in 16% (n = 36), dyslipidemia in 7% (n = 15), and cardiovascular disease in 5% (n = 12). Stroke and obesity were present in 2% (n = 4) and 2% (n = 5) of patients, respectively, while other comorbid conditions were reported in 19% (n = 43).

In terms of dietary adherence among the study population, 17.5% of patients (n = 35) reported following a strict diet regimen, while 54% (n = 108) adhered to a partial diet. A significant proportion, 28.5% (n = 57), were not following any prescribed dietary restrictions.

Assessment of physical activity among the study participants revealed that 4.5% (n = 9) of patients led a sedentary lifestyle, while 44% (n = 88) engaged in light activity. Moderate activity was reported by 40.5% (n = 81), and 13% (n = 26) of participants were regularly active.

Regarding treatment outcomes, 17% of patients (n = 34) achieved complete success, while 15.5% (n = 31) experienced partial success. A smaller proportion, 7% (n = 14), did not achieve the desired outcomes. In 60.5% of participants (n = 121), the measure was not applicable.

In this study of 200 patients with type 2 diabetes mellitus (T2DM), the mean age was 54.3 ± 11.3 years, with a predominance of females (61.5%). This demographic profile is consistent with previous reports where T2DM prevalence is higher among middle-aged and older adults, and some studies have also observed a female predominance [1,2]. The mean duration of diabetes was 8.6 ± 5.76 years, comparable to other clinical cohorts that reported disease duration ranging between 7 and 10 years [3]. Comorbidities were highly prevalent, with hypertension (48%) being the most common, followed by hypothyroidism (16%), dyslipidemia (7%), and cardiovascular disease (5%). These findings are in agreement with Reeve et al., who emphasized that polypharmacy and multiple comorbidities are highly prevalent among older adults with T2DM [4,5]. The high burden of comorbidities underscores the importance of individualized treatment and careful medication review to minimize adverse outcomes.

Medication deprescribing was successfully implemented in a subset of 65 patients, targeting primarily sulfonylureas and insulin, which were completely deprescribed in 31.8% and 34.1% of patients, respectively. Partially deprescribed medications included DPP-4 inhibitors and biguanides in 27.9% and 25.6% of patients, respectively. Similar patterns were reported in other deprescribing studies, which found that high-risk medications, particularly insulin and sulfonylureas, were prioritized due to their potential for hypoglycemia and other adverse events [6,7]. Alpha-glucosidase inhibitors and thiazolidinediones were less frequently deprescribed, reflecting their relatively lower risk profiles and clinician discretion [8]. These observations suggest that structured deprescribing protocols can be safely applied to reduce polypharmacy while maintaining glycemic stability.

Family history and medication adherence significantly influence diabetes management. In this study, 28% of patients had a positive family history of diabetes, and 22% demonstrated non-compliance, with 9.5% classified as highly non-compliant. Comparable studies by Turner et al. and Karlsen et al. have highlighted that both genetic predisposition and behavioral factors, including adherence, are critical determinants of glycemic control and treatment outcomes [9]. Strategies to improve adherence, such as patient education, counseling, and follow-up, remain essential components of comprehensive diabetes care.

Lifestyle factors, including social habits, diet, and physical activity, were also assessed. The majority of patients had no notable habits (73.5%), but a subset reported regular or occasional alcohol consumption (25%) and smoking (1.5%). Dietary adherence was partial or absent in 82.5% of patients, while physical activity was predominantly light to moderate in 84.5% of participants. These findings are consistent with other population-based studies, which demonstrate suboptimal lifestyle practices among patients with T2DM, emphasizing the need for ongoing behavioral interventions to optimize disease management [10].

Regarding treatment outcomes, 17% of patients achieved complete success and 15.5% partial success, with 7% showing no improvement and 60.5% not applicable. This distribution is comparable to results from Reeve et al., where structured interventions, including medication optimization and lifestyle counseling, led to improved outcomes in a subset of patients, but variability remained due to differences in baseline characteristics, adherence, and comorbidity burden. Overall, the present study reinforces the importance of an integrated approach that combines deprescribing, adherence monitoring, lifestyle modification, and individualized treatment to optimize outcomes in T2DM patients. 

The present study shows that patients with type 2 diabetes mellitus often present with multiple comorbidities, suboptimal lifestyle practices, and variable medication adherence, contributing to the complexity of disease management. Medication deprescribing, particularly of high-risk agents such as sulfonylureas and insulin, was feasible and effective in reducing polypharmacy without compromising glycemic control. Lifestyle factors, including diet and physical activity, along with patient education and adherence monitoring, play a critical role in achieving favorable treatment outcomes. Overall, an integrated, patient-centered approach that combines careful deprescribing, lifestyle modification, and regular follow-up can optimize clinical outcomes and improve quality of life in patients with type 2 diabetes mellitus.

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