Healthcare Professionals' Priorities for Guidelines on Deprescribing Antihyperglycemics: A Mixed-Methods Study.

Abstract

For older adults living with frailty and type 2 diabetes, reassessing the appropriateness of medications is important. This may include consideration of deprescribing (reducing or stopping) antihyperglycemic medications. Our deprescribing.org team created a guideline for deprescribing antihyperglycemics in 2017. To inform a guideline update, we conducted a prioritization exercise to ensure our update addresses current healthcare professional (HCP) needs and priorities. The aim was to establish HCP priorities with regards to the guideline topics, outcomes, and knowledge translation materials included with the 2017 guideline and identify gaps in the content to be added to the update. We conducted a sequential explanatory mixed-methods study between April and June 2025, including a survey open to participants globally, followed by focus groups open to participants in Canada. Quantitative survey data were analyzed using descriptive statistics. Qualitative data within the survey and focus group discussions were analyzed using summative content analysis and conventional content analysis, respectively. All guideline topics proposed in the survey were considered either "extremely important" or "important" by the majority of participants. The outcome considered most critical for decision-making when deprescribing was clinical symptoms of hypoglycemia (91%). As a knowledge translation tool, a decision-support algorithm was considered important or extremely important by 84% of respondents. Qualitative findings highlighted considerations for incorporating novel antihyperglycemic agents into deprescribing decisions, cost implications for the patient, and knowledge translation resources (e.g., reporting templates) to support clear communication between prescribers, and patient education materials. The topics and outcomes included in deprescribing.org's 2017 antihyperglycemic deprescribing guideline were all considered important or extremely important by HCPs and therefore we will recommend that these be carried forward into the new guideline. Next steps will include reporting HCP priorities to the guideline panel and updating the systematic review for the guideline.