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De-intensification medications (D-Med study)

Evaluation of an electronic decision-support system, plus training with follow-up support and performance review, for the deintensification of potentially inappropriate medications (D-Med) to prevent overtreatment in the management of older frail people with type 2 diabetes: a 12-month follow-up cluster randomised trial 

Why the research is needed? 

In the management of older people with type 2 diabetes, patients are sometimes prescribed inappropriate diabetes medications. Over-prescribing of medication can lead to blood sugar dropping to dangerous levels which increases the likelihood of falls, emergency hospital admissions and death. Guidelines are available but there is often therapeutic inertia which means the healthcare providers fail to provide the necessary treatment to de-intensify the medications prescribed,

What is already known about the subject? 

Therapeutic inertia is a complex problem and involves different problems to do with healthcare providers, patients and healthcare settings - all having an effect on the overall problem. In older people with diabetes, therapeutic inertia leads to potentially inappropriate medications not been stopped or changed. A lack of clear guidelines and training means that GPs and practice nurses are not confident in stopping, reducing or switching diabetes medications, and there is no clear process in place to support them. Therefore, we aim to develop and test an intervention which will deal with this problem.  

Who we are working with? 

We are working with local GPs and practice nurses to help us with the design and delivery of our intervention. We are also working with a software company (PRIMIS) to produce a digital solution for our intervention to improve the process of stopping diabetes treatments promptly and effectively.  

How are patients and the public involved? 

We are involving people who have diabetes, by engaging them in the research process from the start, to ensure that our aims and outcomes match what they want and expect.  

What we will do? 

We will recruit 40 GP practices from locations across England to take part. Practices will be randomly allocated to one of two groups: either a usual care group (this involves the practice continuing with the normal routine care for the management of older people with type 2 diabetes) or an enhanced care intervention group (this involves practices being trained on new guidelines, specifically targeting older people with type 2 diabetes, and being prompted and supported, with the help of digital technology, to stop, reduce or switch potentially inappropriate diabetes medications). We will compare the two groups, at the start of the study and at 12 months, to find out if the intervention makes a difference to the number of potentially inappropriate diabetes medications being prescribed in older patients. 

What the benefits will be? 

This research will potentially reduce therapeutic inertia and improve the management of older people with type 2 diabetes. This will result in a reduction in hypoglycaemic events, falls and unnecessary hospital admissions. 

When the findings will be available? 

We plan to have findings available by the end of 2024. 

How we are planning for implementation? 

We are planning for implementation by developing a communications plan aimed at the widest possible audience, to promote awareness about the study.  


Lauren O'Mahoney,