Evidence map›Paper›PMID 37940754›Full record

ArticleJournal of general internal medicine2024

A National Survey of Physicians' Views on the Importance and Implementation of Deintensifying Diabetes Medications.

Scott J Pilla, Rabia Jalalzai, Olive Tang, Nancy L Schoenborn, Cynthia M Boyd, Michael P Bancks, Nestoras N Mathioudakis, Nisa M Maruthur

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.8field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

  1. Article
  2. A National Physician Survey Examining Switching From Sulfonylureas or Insulin to Newer Diabetes Medications.Clinical diabetes : a publication of the American Diabetes Association · 2025
    Article
  3. Minimising harms of tight glycaemic control in older patients with type 2 diabetes.African journal of primary health care & family medicine · 2024
    Article
  4. Crossing the deintensification chasm for older adults with diabetes.Journal of the American Geriatrics Society · 2024
    Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Scott J PillaDepartment of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. spilla1@jhmi.edu.ORCID 0000-0002-3292-9047
Rabia JalalzaiDepartment of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Olive TangDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Nancy L SchoenbornDepartment of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Cynthia M BoydDepartment of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Michael P BancksDepartment of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Nestoras N MathioudakisDepartment of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nisa M MaruthurDepartment of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins University · USWake Forest University · US

Funding

U.S. Deprescribing Research NetworkR24AG064025 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI CYNTHIA Melinda BOYD, MICHAEL A. STEINMAN · 2023 to 2023
$3.8M
NCATS NIH HHS KL2 TR003099NIA NIH HHS 1R24AG064025NIA NIH HHS K24 AG056578NIA NIH HHS K24AG056578NIA NIH HHS K76 AG059984NIA NIH HHS K76AG059984NIA NIH HHS R24 AG064025NIA NIH HHS R24AG064025NIDDK NIH HHS K23 DK128572NIDDK NIH HHS K23DK128572
6 · The paper itself

Abstract

backgroundGuidelines recommend deintensifying hypoglycemia-causing medications for older adults with diabetes whose hemoglobin A1c is below their individualized target, but this rarely occurs in practice.

objectiveTo understand physicians' decision-making around deintensifying diabetes treatment.

designNational physician survey.

participantsUS physicians in general medicine, geriatrics, or endocrinology providing outpatient diabetes care. MAIN MEASURES: Physicians rated the importance of deintensifying diabetes medications for older adults with type 2 diabetes, and of switching medication classes, on 5-point Likert scales. They reported the frequency of these actions for their patients, and listed important barriers and facilitators. We evaluated the independent association between physicians' professional and practice characteristics and the importance of deintensifying and switching diabetes medications using multivariable ordered logistic regression models. KEY

resultsThere were 445 eligible respondents (response rate 37.5%). The majority of physicians viewed deintensifying (80%) and switching (92%) diabetes medications as important or very important to the care of older adults. Despite this, one-third of physicians reported deintensifying diabetes medications rarely or never. While most physicians recognized multiple reasons to deintensify, two-thirds of physicians reported barriers of short-term hyperglycemia and patient reluctance to change medications or allow higher glucose levels. In multivariable models, geriatricians rated deintensification as more important compared to other specialties (p=0.027), and endocrinologists rated switching as more important compared to other specialties (p<0.006). Physicians with fewer years in practice rated higher importance of deintensification (p<0.001) and switching (p=0.003).

conclusionsWhile most US physicians viewed deintensifying and switching diabetes medications as important for the care of older adults, they deintensified infrequently. Physicians had ambivalence about the relative benefits and harms of deintensification and viewed it as a potential source of conflict with their patients. These factors likely contribute to clinical inertia, and studies focused on improving shared decision-making around deintensifying diabetes medications are needed.

Indexed as

Attitude of Health PersonnelDiabetes Mellitus, Type 2Hypoglycemic AgentsAdultAgedFemaleGlycated HemoglobinHumansHypoglycemiaMaleMiddle AgedPhysiciansPractice Patterns, Physicians'Surveys and QuestionnairesUnited StatesGlycated HemoglobinHypoglycemic Agentsagingdeprescriptionsdiabetes mellitus, type 2drug-related side effects and adverse reactionshypoglycemia

Identifiers

PMID37940754
PMCPMC11074084
OpenAlexW4388488388

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.