Deprescribing: lifestyle modification to reduce or eliminate diabetes medications

The number of people living with diabetes is expected to grow from 382 million adults to more than 592 million by 2035.¹ As those numbers rise, the number of plan members needing help managing their condition will also grow exponentially. But unlike other chronic conditions, type 2 diabetes, for some, can be managed with changes to diet and exercise. It is possible to reduce the amount of diabetes-related medication needed – or cease the use of medication altogether – by monitoring diet, increasing levels of exercise, and safely titrating down the amount of medication taken.

“Holistic:” The next frontier of diabetes care

Diabetes management has historically focused on monitoring blood sugar and continuity of medications, but the next frontier of diabetes care must proactively manage all aspects of health, particularly nutrition. Diabetes affects whole health and should be addressed holistically, with attention to a wide range of factors, including blood glucose levels, medication adherence and optimization, lifestyle, nutrition, comorbidity management, and guideline-driven screenings. Nutrition has emerged as a key area of focus because weight loss can dramatically impact diabetes status. Research has shown that losing 5 percent of one’s body weight can help keep blood sugar under control and may even help reduce or eliminate the need for certain medications.²

The role of diet in successful diabetes management

To date, most clinical trials have compared the effectiveness of specific dietary approaches at improving diabetes outcomes. At the individual level, we know that a variety of dietary approaches can be effective. From clinical practice, we also know that people can move between dietary patterns and reap health benefits.³ For many members, adhering to one type of specific diet would prove challenging, and needs change over time. We use data to create individualized and more sustainable action plans. Taking preferences and lifestyle into account, along with technology and glucose monitors that offer real-time feedback, it’s possible to personalize and tailor nutrition plans. Smartphone apps and data sharing with glucose monitors make this vision a reality.

Comprehensive nutrition programs take history into account, as well as lifestyle habits. For example, does the member like to cook? Do they enjoy eating out at restaurants? Does their schedule allow for dinners at home, or do they tend to eat on the go? A personalized plan of action incorporates these inputs and offers recommendations for success. This approach increases the likelihood of adherence, allows members to experience early success, and sets the stage for sustained focus on improved lifestyle.

What is deprescribing?

Diet changes that lead to weight loss may allow some members with type 2 diabetes to adjust or even eliminate the need for certain medications. Their provider can look to data to see if titrating down a medication is possible, reducing the medication burden and maintaining or even improving quality of life.

Deprescribing is ”the process of withdrawal of a medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes.”⁴ Based on the member and the provider’s clinical expertise, optimizing medication dose is possible as lifestyle modifications take effect. Often, this process leverages the guidance of a dietician and endocrinologist in coordination with the member’s primary care provider.

The future of deprescribing

The health care industry is exploring how deprescribing may translate to other chronic conditions. If a chronic condition necessitates medication, but that condition can also be positively impacted through lifestyle change, it stands to reason that there is the potential for deprescribing. The concept is expected to grow across clinical care in the coming decade, especially as clinical data become available to support the concept of deprescription of medications for chronic conditions.