Deprescribing Antidiabetic Agents to Prevent Hypoglycemia as an Adverse Drug Reaction in Elderly Patients: A Narrative Review
Keywords:
Deprescribing, Antidiabetic, Adverse Drug Reaction, ElderlyAbstract
Background: Older adults with diabetes experience high rates of drug-induced hypoglycemia, driven primarily by insulin and sulfonylurea therapies. However, clinical inertia and fear of rebound hyperglycemia frequently impede routine medication de-escalation in clinical practice. Objective: This review synthesizes current evidence regarding antidiabetic-induced hypoglycemia risk profiles and actionable implementation strategies for deprescribing in older adults. Methods: A literature search was conducted in PubMed and Google Scholar (2016–2026) for primary research evaluating antidiabetic hypoglycemia risk and the feasibility of deprescribing in geriatric populations. Four primary original research studies met the inclusion criteria for detailed synthesis. Results: Deprescribing high-risk antidiabetic agents significantly reduces severe hypoglycemia, particularly among vulnerable individuals with renal insufficiency, while safely maintaining stable glycemic control. Successful execution relies on interprofessional collaboration between primary care providers and pharmacists, utilizing strategies such as academic detailing, pre-visit planning, educational brochures, and direct clinical interventions. Conclusion: Embedding multidisciplinary deprescribing frameworks into primary care transitions diabetes management away from rigid glycemic targets toward safer, individualized, and patient-centered care.
References
Al-Azayzih, A., Kanaan, R. J., Altawalbeh, S. M., Alzoubi, K. H., Kharaba, Z., & Jarab, A. (2024). Prevalence and predictors of hypoglycemia in older outpatients with type 2 diabetes mellitus. PLoS ONE, 19(8), 1–13. https://doi.org/10.1371/journal.pone.0309618
Atlas IDF. (2022). Diabetes around the world. Current Status of Prevention and Treatment of Diabetic Complications: Proceedings of the Third International Symposium on Treatment of Diabetes Mellitus. ICS821, 116–122.
Bradley, M. D., Arnold, M. E., Biskup, B. G., Campbell, T. M. 2nd, Fuhrman, J., Guthrie, G. E., Kelly, J. H., Lacagnina, S., Loomis, J. F., McMacken, M. M., Trapp, C., & Karlsen, M. C. (2023). Medication Deprescribing Among Patients With Type 2 Diabetes: A Qualitative Case Series of Lifestyle Medicine Practitioner Protocols. Clinical Diabetes : A Publication of the American Diabetes Association, 41(2), 163–176. https://doi.org/10.2337/cd22-0009
Busque, K., Blackmore, E. R., Fox, D., Foli, K., Wold, K., & Fendelander, J. (2025). Pharmacist-led sulfonylurea deprescribing in older adults. Journal of the American Pharmacists Association : JAPhA, 65(3), 102387. https://doi.org/10.1016/j.japh.2025.102387
Florentin, M., Kostapanos, M. S., & Papazafiropoulou, A. K. (2022). Role of dipeptidyl peptidase 4 inhibitors in the new era of antidiabetic treatment. World Journal of Diabetes, 13(2), 85–96. https://doi.org/10.4239/wjd.v13.i2.85
Grant, R. W., Peterson, I., McCloskey, J. M., Lipska, K. J., Nugent, J., Karter, A. J., & Gilliam, L. K. (2025). Diabetes Deprescribing in Older Adults: A Randomized Clinical Trial. JAMA Internal Medicine, 185(8), 926–935. https://doi.org/10.1001/jamainternmed.2025.2015
Hope, S. V, Taylor, P. J., Shields, B. M., Hattersley, A. T., & Hamilton, W. (2018). Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia. Primary Care Diabetes, 12(2), 139–146. https://doi.org/10.1016/j.pcd.2017.08.004
Jones, K. F., Stolzmann, K., Wormwood, J., Pendergast, J., Miller, C. J., Still, M., Bokhour, B. G., Hanlon, J., Simon, S. R., Rosen, A. K., & Linsky, A. M. (2024). Patient-Directed Education to Promote Deprescribing: A Nonrandomized Clinical Trial. JAMA Internal Medicine, 184(11), 1339–1346. https://doi.org/10.1001/jamainternmed.2024.4739
Leonard, C. E., Han, X., Brensinger, C. M., Bilker, W. B., Cardillo, S., Flory, J. H., & Hennessy, S. (2018). Comparative risk of serious hypoglycemia with oral antidiabetic monotherapy: A retrospective cohort study. Pharmacoepidemiology and Drug Safety, 27(1), 9–18. https://doi.org/10.1002/pds.4337
Li, X.-T., & Yun, M.-Z. (2025). The impact of sulfonylureas on diverse ion channels: an alternative explanation for the antidiabetic actions. Frontiers in Cell and Developmental Biology, Volume 13. https://www.frontiersin.org/journals/cell-and-developmental-biology/articles/10.3389/fcell.2025.1528369
Ling, S., Zaccardi, F., Lawson, C., Seidu, S. I., Davies, M. J., & Khunti, K. (2021). Glucose Control, Sulfonylureas, and Insulin Treatment in Elderly People With Type 2 Diabetes and Risk of Severe Hypoglycemia and Death: An Observational Study. Diabetes Care, 44(4), 915–924. https://doi.org/10.2337/dc20-0876
Mehnaz, S., Shravya, P., Palagiri, S., Shivani, S., & Visalakshi, K. (2025). A Study on Medication Deprescribing Among Patients with Type 2 Diabetes Mellitus. European Journal of Cardiovascular Medicine, 15, 155–160. https://doi.org/10.61336/EJCM/25-09-28
Samajdar, S. S., & Joshi, S. R. (2025). The A–G Mnemonic: A Practical Framework for Deprescribing in Older Adults With Type 2 Diabetes. Diabetes Care, 48(10), e119–e121. https://doi.org/10.2337/dc25-1348
Shariff, A., Sridhar, S. B., Bittar, H. R., Hamad, A., Ahmed, R., & Kadour, G. (2019). Frequency and Predisposing Factors for Drug-Induced Hypoglycemia in Patients with Type-2 Diabetes Mellitus. Journal of Research in Pharmacy Practice, 8(2), 64–68. https://doi.org/10.4103/jrpp.JRPP_18_58
Standards of Care in Diabetes—2026. (2025). Diabetes Care, 49(Supplement_1), S277–S296. https://doi.org/10.2337/dc26-S013
Starke, P., Thürmann, P., Grobe, T., Friede, T., & Mathes, T. (2025). Real-World Harm Reduction of Metformin Plus DPP4 Inhibitors versus Metformin Plus Sulfonylureas in Older Adults: A Target Trial Emulation Using German Claims Data. Drugs & Aging, 42(7), 655–663. https://doi.org/10.1007/s40266-025-01218-0
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