MON-532 Deprescribing inappropriate sulfonylurea medications in adults over 65 with T2DM

Abstract Disclosure: K. Sheikh: None. Background: Elderly patients with type 2 diabetes mellitus (T2DM) using insulin and insulin secretagogues, particularly sulfonylureas, face increased hypoglycemia risk due to renal impairment, inconsistent meal intake, and cognitive decline. The American Diabetes Association and the American Geriatrics Society recommend relaxed HbA1c targets and advise against sulfonylurea use in older adults due to risks like falls, cardiovascular events, and mortality. This study aimed to reduce sulfonylurea prescriptions among veterans aged 65+ receiving primary care at the Central Texas VA to improve patient safety. Methods: The study was conducted at the internal medicine residency clinic at the Central Texas VA. After obtaining approval, a chart review identified 31 eligible patients (age ≥65, T2DM, HbA1c ≤7.5%) with an active sulfonylurea prescription. Patients were excluded for various reasons, including prior de-prescription, HbA1c >7.5% before contact, non-VA diabetes management, outdated HbA1c, or death, leaving 19 participants. Over eight weeks, resident physicians conducted phone calls during quality improvement sessions to educate patients about de-prescribing. If patients agreed, their sulfonylurea prescription was discontinued, patients were instructed to stop taking the medication, and their diabetes regimens were adjusted as needed. Results: By study completion, 74% (14/19) of patients discontinued sulfonylureas, surpassing the 50% target. Discussion: This low-resource intervention effectively reduced sulfonylurea use among elderly veterans. Sulfonylureas, now considered third- or fourth-line diabetes treatments, pose significant risks, including severe hypoglycemia and hospitalization. The study highlights that many elderly patients receive potentially harmful prescriptions, even in academic settings, but de-prescription is feasible with simple interventions like chart reviews and phone consultations. Most patients were open to discontinuation when risks and benefits were explained. Further data collection on patients’ glycemic control after the de-prescribing intervention is ongoing. Presentation: Monday, July 14, 2025