Finding the treatment sweet spot
This isn’t just an issue for people with diabetes – it’s an issue for anyone living with a chronic condition.
So how do we encourage appropriate deintensification in order to get to the sweet spot for treatment? There are many changes that could help.
First, health care systems should institute programs that systematically engage providers and patients to consider stopping medications that are no longer necessary.
For example, the VA has instituted a national “Hypoglycemia Safety Initiative“ to encourage appropriate deintensification of diabetes medications in order to decrease the harm of intensive treatment among those at risk for hypoglycemia (low blood sugar).
Second, patients should ask their providers if their medications are still necessary. Some could possibly be stopped or the dose decreased. Providers should regularly reexamine their patients’ medication lists and discuss the options.
Third, while existing clinical practice guidelines already say that treatment should be based on risk and benefits for an individual patient, these guidelines should go a step further and include explicit recommendations for deintensification to help providers and patients decide when stopping a medication might be wise.
Fourth, the way we assess whether doctors are providing high-quality care should look not just at whether high-intensity treatment is provided for a patient, but also if doctors are deintensifying treatment when possible and beneficial.
Finally, we must get out the message that more is not always better. Campaigns such as Choosing Wisely®, in conjunction with Consumer Reports, educate the public about care that might not be needed, but only 21% of US doctors surveyed were aware of the campaign.
Changing the “more is better” mindset among both patients and providers will not be easy, but it will be essential if we want to ensure that patients get the treatments they need but not those that are unnecessary and potentially harmful.
Eve A Kerr, Professor of Internal Medicine, University of Michigan; Jeremy Sussman, Assistant Professor of Internal Medicine, University of Michigan, and Tanner Caverly, Clinical Lecturer, University of Michigan