(P-198) Pharmacist-led Intervention to Support Deprescribing of Cardiometabolic Medication Among People with Type 2 Diabetes: A Pilot Study

Background: To reduce overtreatment and the risk of side effects, timely deprescribing of cardiometabolic medication is essential in older people with type 2 diabetes (T2D). Deprescribing is still uncommon in this population and healthcare providers in primary care have expressed the need for more support to implement deprescribing.

Objectives: To investigate the potential impact of a pharmacist-led intervention to support deprescribing among T2D patients.

Methods: A pilot study was conducted to assess the impact of an intervention led by 14 pharmacists in The Netherlands, combining a single-arm observational study and a non-randomised controlled before-after (CBA) study. People with T2D and a high age-, sex-, medication-related hypoglycemia risk score were included between December 2019 and April 2020. The intention was to include 10 intervention and 10 control patients per pharmacy. The intervention consisted of a tailored clinical medication review conducted by pharmacists together with general practitioners aimed at reducing overtreatment with cardiometabolic medication and risk of hypoglycaemia. The main outcome was the percentage of intervention patients receiving an intervention-related action. In the CBA study, the difference in percentage of patients with at least one cardiometabolic medication stopped or reduced was assessed between intervention and control patients with Fischer’s exact test.

Results: In total 90 intervention patients and 107 control patients were included, with an average age of 70 and 71 years, respectively. They used on average 10 medications, 5 of which were cardiometabolic medication. All intervention patients received a medication review consultation. At least one intervention-related action was implemented in 45 of the intervention patients (50%), including deprescribing of cardiometabolic medication for 25 patients and advice about this medication for 22 patients. In the CBA study, the proportion of patients with at least one cardiometabolic medication stopped or reduced in dose three months after baseline was 48% for the intervention group as compared to 31% for the control group (p-value 0.018).

Conclusions: A pharmacist-led intervention aimed at people with T2D and a high hypoglycemia risk has a potential impact to reduce this risk in around half of these patients, and may lead to significantly more deprescribing of cardiometabolic medication than usual care. Inclusion of patients in this pilot study was limited by the Covid pandemic. Further process evaluation will be conducted to assess the patients’ and healthcare providers’ satisfaction and implementation of the intervention.