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A National Survey of Physicians’ Views on the Importance and Implementation of Deintensifying Diabetes Medications

  • Original Research
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Abstract

Background

Guidelines recommend deintensifying hypoglycemia-causing medications for older adults with diabetes whose hemoglobin A1c is below their individualized target, but this rarely occurs in practice.

Objective

To understand physicians’ decision-making around deintensifying diabetes treatment.

Design

National physician survey.

Participants

US physicians in general medicine, geriatrics, or endocrinology providing outpatient diabetes care.

Main Measures

Physicians rated the importance of deintensifying diabetes medications for older adults with type 2 diabetes, and of switching medication classes, on 5-point Likert scales. They reported the frequency of these actions for their patients, and listed important barriers and facilitators. We evaluated the independent association between physicians’ professional and practice characteristics and the importance of deintensifying and switching diabetes medications using multivariable ordered logistic regression models.

Key Results

There were 445 eligible respondents (response rate 37.5%). The majority of physicians viewed deintensifying (80%) and switching (92%) diabetes medications as important or very important to the care of older adults. Despite this, one-third of physicians reported deintensifying diabetes medications rarely or never. While most physicians recognized multiple reasons to deintensify, two-thirds of physicians reported barriers of short-term hyperglycemia and patient reluctance to change medications or allow higher glucose levels. In multivariable models, geriatricians rated deintensification as more important compared to other specialties (p=0.027), and endocrinologists rated switching as more important compared to other specialties (p<0.006). Physicians with fewer years in practice rated higher importance of deintensification (p<0.001) and switching (p=0.003).

Conclusions

While most US physicians viewed deintensifying and switching diabetes medications as important for the care of older adults, they deintensified infrequently. Physicians had ambivalence about the relative benefits and harms of deintensification and viewed it as a potential source of conflict with their patients. These factors likely contribute to clinical inertia, and studies focused on improving shared decision-making around deintensifying diabetes medications are needed.

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Data Availability

The datasets used in the current study will be available from the corresponding author on reasonable request, after the primary manuscripts are published.

References

  1. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 13. Older Adults: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Supplement_1):S216-S29. doi:https://doi.org/10.2337/dc23-S013.

    Article  CAS  PubMed  Google Scholar 

  2. American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus, Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020-6. doi:https://doi.org/10.1111/jgs.12514.

    Article  Google Scholar 

  3. Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus. Ann Intern Med. 2017;167(9):655-63. doi:https://doi.org/10.7326/M17-1362.

    Article  PubMed  Google Scholar 

  4. LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, et al. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019. doi:https://doi.org/10.1210/jc.2019-00198.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med. 2008;149(1):11-9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pilla SJ, Schoenborn NL, Maruthur NM, Huang ES. Approaches to Risk Assessment Among Older Patients With Diabetes. Curr Diab Rep. 2019;19(8):59. doi:https://doi.org/10.1007/s11892-019-1172-z.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee AK, Lee CJ, Huang ES, Sharrett AR, Coresh J, Selvin E. Risk Factors for Severe Hypoglycemia in Black and White Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 2017;40(12):1661-7. doi:https://doi.org/10.2337/dc17-0819.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lipska KJ, Ross JS, Wang Y, Inzucchi SE, Minges K, Karter AJ, et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014;174(7):1116-24. doi:https://doi.org/10.1001/jamainternmed.2014.1824.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC, Jr., Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-59. doi:https://doi.org/10.1056/NEJMoa0802743.

    Article  Google Scholar 

  10. Bonds DE, Miller ME, Bergenstal RM, Buse JB, Byington RP, Cutler JA, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909. doi:https://doi.org/10.1136/bmj.b4909.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lega IC, Campitelli MA, Austin PC, Na Y, Zahedi A, Leung F, et al. Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study. Diabetologia. 2021;64(5):1093-102. doi:https://doi.org/10.1007/s00125-020-05370-7.

    Article  CAS  PubMed  Google Scholar 

  12. Pilla SJ, Kraschnewski JL, Lehman EB, Kong L, Francis E, Poger JM, et al. Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems. BMJ Open Diabetes Res Care. 2021;9(Suppl 1). doi:https://doi.org/10.1136/bmjdrc-2021-002153.

  13. Bloomfield HE, Greer N, Newman D, MacDonald R, Carlyle M, Fitzgerald P, et al. Predictors and Consequences of Severe Hypoglycemia in Adults with Diabetes - A Systematic Review of the Evidence. Washington (DC)2012.

  14. Zhao Y, Kachroo S, Kawabata H, Colilla S, Mukherjee J, Fonseca V, et al. Association between Hypoglycemia and Fall-Related Fractures and Health Care Utilization in Older Veterans with Type 2 Diabetes. Endocr Pract. 2016;22(2):196-204. doi:https://doi.org/10.4158/EP15640.OR.

    Article  PubMed  Google Scholar 

  15. Cox DJ, Kovatchev B, Vandecar K, Gonder-Frederick L, Ritterband L, Clarke W. Hypoglycemia preceding fatal car collisions. Diabetes Care. 2006;29(2):467-8. doi:https://doi.org/10.2337/diacare.29.02.06.dc05-1836.

    Article  PubMed  Google Scholar 

  16. Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010;363(15):1410-8. doi:https://doi.org/10.1056/NEJMoa1003795.

    Article  CAS  PubMed  Google Scholar 

  17. Barendse S, Singh H, Frier BM, Speight J. The impact of hypoglycaemia on quality of life and related patient-reported outcomes in Type 2 diabetes: a narrative review. Diabet Med. 2012;29(3):293-302. doi:https://doi.org/10.1111/j.1464-5491.2011.03416.x.

    Article  CAS  PubMed  Google Scholar 

  18. Rossi MC, Nicolucci A, Ozzello A, Gentile S, Aglialoro A, Chiambretti A, et al. Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study. Nutr Metab Cardiovasc Dis. 2019;29(7):736-43. doi:https://doi.org/10.1016/j.numecd.2019.04.009.

    Article  PubMed  Google Scholar 

  19. McCoy RG, Herrin J, Galindo RJ, Sindhu Swarna K, Umpierrez GE, Hill Golden S, et al. All-cause mortality after hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes, 2011-2020. Diabetes Res Clin Pract. 2023;197:110263. doi:https://doi.org/10.1016/j.diabres.2023.110263.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Farrell B, Black C, Thompson W, McCarthy L, Rojas-Fernandez C, Lochnan H, et al. Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline. Can Fam Physician. 2017;63(11):832-43.

    PubMed  PubMed Central  Google Scholar 

  21. Oktora MP, Kerr KP, Hak E, Denig P. Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review. Diabet Med. 2021;38(2):e14408. doi:https://doi.org/10.1111/dme.14408.

    Article  CAS  PubMed  Google Scholar 

  22. Pilla SJ, Meza KA, Schoenborn NL, Boyd CM, Maruthur NM, Chander G. A Qualitative Study of Perspectives of Older Adults on Deintensifying Diabetes Medications. J Gen Intern Med. 2022. doi:https://doi.org/10.1007/s11606-022-07828-3.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pilla SJ, Jalalzai R, Tang O, Schoenborn NL, Boyd CM, Golden SH, et al. A National Physician Survey of Deintensifying Diabetes Medications for Older Adults With Type 2 Diabetes. Diabetes Care. 2023. doi:https://doi.org/10.2337/dc22-2146.

    Article  PubMed  Google Scholar 

  24. American Medical Association Physician Masterfile [internet]. American Medical Association [accessed 2022 Sept 8]. Available from: https://www.ama-assn.org/about/masterfile/ama-physician-masterfile.

  25. Radhakrishnan A, Nowak SA, Parker AM, Visvanathan K, Pollack CE. Linking physician attitudes to their breast cancer screening practices: A survey of US primary care providers and gynecologists. Prev Med. 2018;107:90-102. doi:https://doi.org/10.1016/j.ypmed.2017.11.010.

    Article  PubMed  Google Scholar 

  26. Tseng E, Greer RC, O'Rourke P, Yeh HC, McGuire MM, Albright AL, et al. National Survey of Primary Care Physicians' Knowledge, Practices, and Perceptions of Prediabetes. J Gen Intern Med. 2019;34(11):2475-81. doi:https://doi.org/10.1007/s11606-019-05245-7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Goyal P, Anderson TS, Bernacki GM, Marcum ZA, Orkaby AR, Kim D, et al. Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults. J Am Geriatr Soc. 2020;68(1):78-86. doi:https://doi.org/10.1111/jgs.16157.

    Article  PubMed  Google Scholar 

  28. Garvey KC, Telo GH, Needleman JS, Forbes P, Finkelstein JA, Laffel LM. Health Care Transition in Young Adults With Type 1 Diabetes: Perspectives of Adult Endocrinologists in the U.S. Diabetes Care. 2016;39(2):190-7. doi:https://doi.org/10.2337/dc15-1775.

    Article  CAS  PubMed  Google Scholar 

  29. Kazzazi F, Haggie R, Forouhi P, Kazzazi N, Malata CM. Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys. Patient Relat Outcome Meas. 2018;9:169-72. doi:https://doi.org/10.2147/PROM.S156109.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jepson C, Asch DA, Hershey JC, Ubel PA. In a mailed physician survey, questionnaire length had a threshold effect on response rate. J Clin Epidemiol. 2005;58(1):103-5. doi:https://doi.org/10.1016/j.jclinepi.2004.06.004.

    Article  PubMed  Google Scholar 

  31. West BT, Zhang S, Wagner J, Gatward R, Saw HW, Axinn WG. Methods for improving participation rates in national self-administered web/mail surveys: Evidence from the United States. PLoS One. 2023;18(8):e0289695. doi:https://doi.org/10.1371/journal.pone.0289695.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Greenhalgh T, Jackson C, Shaw S, Janamian T. Achieving Research Impact Through Co-creation in Community-Based Health Services: Literature Review and Case Study. Milbank Q. 2016;94(2):392-429. doi:https://doi.org/10.1111/1468-0009.12197.

    Article  PubMed  PubMed Central  Google Scholar 

  33. American Diabetes Association Professional Practice Committee, Draznin B, Aroda VR, Bakris G, Benson G, et al. 13. Older Adults: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Supplement_1):S195-S207. doi:https://doi.org/10.2337/dc22-S013.

    Article  Google Scholar 

  34. Beatty PC, Willis GB. Research Synthesis: The Practice of Cognitive Interviewing. Public Opinion Quarterly. 2007;71(2):287-311. doi:https://doi.org/10.1093/poq/nfm006.

    Article  Google Scholar 

  35. Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544. doi:https://doi.org/10.1136/bmjopen-2014-006544.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Williams R. Understanding and interpreting generalized ordered logit models. The Journal of Mathematical Sociology. 2016;40(1):7-20. doi:https://doi.org/10.1080/0022250X.2015.1112384.

    Article  Google Scholar 

  37. Schoenborn NL, Massare J, Park R, Boyd CM, Choi Y, Pollack CE. Assessment of Clinician Decision-making on Cancer Screening Cessation in Older Adults With Limited Life Expectancy. JAMA Netw Open. 2020;3(6):e206772. doi:https://doi.org/10.1001/jamanetworkopen.2020.6772.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Schoenborn NL, Boyd CM, Pollack CE. Physician Attitudes About Using Life Expectancy to Inform Cancer Screening Cessation in Older Adults-Results From a National Survey. JAMA Intern Med. 2022;182(11):1229-31. doi:https://doi.org/10.1001/jamainternmed.2022.4316.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Schoenborn NL, Janssen EM, Boyd C, Bridges JFP, Wolff AC, Xue QL, et al. Older Adults' Preferences for Discussing Long-Term Life Expectancy: Results From a National Survey. Ann Fam Med. 2018;16(6):530-7. doi:https://doi.org/10.1370/afm.2309.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Schoenborn NL, Lee K, Pollack CE, Armacost K, Dy SM, Bridges JFP, et al. Older Adults' Views and Communication Preferences About Cancer Screening Cessation. JAMA Intern Med. 2017;177(8):1121-8. doi:https://doi.org/10.1001/jamainternmed.2017.1778.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Green AR, Aschmann H, Boyd CM, Schoenborn N. Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults. JAMA Netw Open. 2021;4(4):e212633. doi:https://doi.org/10.1001/jamanetworkopen.2021.2633.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Resnick B. Health promotion practices of older adults: testing an individualized approach. J Clin Nurs. 2003;12(1):46-55; discussion 6. doi:https://doi.org/10.1046/j.1365-2702.2003.00700.x.

    Article  PubMed  Google Scholar 

  43. Reeve E. Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice. J Pharm Pract Res. 2020;50(1):98-107. doi:https://doi.org/10.1002/jppr.1626.

    Article  Google Scholar 

  44. Genere N, Sargis RM, Masi CM, Nathan AG, Quinn MT, Huang ES, et al. Physician perspectives on de-intensifying diabetes medications. Medicine (Baltimore). 2016;95(46):e5388. doi:https://doi.org/10.1097/MD.0000000000005388.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Munshi MN, Slyne C, Segal AR, Saul N, Lyons C, Weinger K. Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia. JAMA Intern Med. 2016;176(7):1023-5. doi:https://doi.org/10.1001/jamainternmed.2016.2288.

    Article  PubMed  Google Scholar 

  46. Pratley RE, Rosenstock J, Heller SR, Sinclair A, Heine RJ, Kiljanski J, et al. Reduced Glucose Variability With Glucose-Dependent Versus Glucose-Independent Therapies Despite Similar Glucose Control and Hypoglycemia Rates in a Randomized, Controlled Study of Older Patients With Type 2 Diabetes Mellitus. J Diabetes Sci Technol. 2018;12(6):1184-91. doi:https://doi.org/10.1177/1932296818776993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Heller SR, Pratley RE, Sinclair A, Festa A, Kiljanski J, Brusko CS, et al. Glycaemic outcomes of an Individualized treatMent aPproach for oldER vulnerable patIents: A randomized, controlled stUdy in type 2 diabetes Mellitus (IMPERIUM). Diabetes Obes Metab. 2018;20(1):148-56. doi:https://doi.org/10.1111/dom.13051.

    Article  CAS  PubMed  Google Scholar 

  48. Sinclair AJ, Heller SR, Pratley RE, Duan R, Heine RJ, Festa A, et al. Evaluating glucose-lowering treatment in older people with diabetes: Lessons from the IMPERIUM trial. Diabetes Obes Metab. 2020;22(8):1231-42. doi:https://doi.org/10.1111/dom.14013.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Pilla SJ, Shahidzadeh Yazdi Z, Taylor SI. Individualized Glycemic Goals for Older Adults Are a Moving Target. Diabetes Care. 2022;45(5):1029-31. doi:https://doi.org/10.2337/dci22-0004.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Huang ES. Management of diabetes mellitus in older people with comorbidities. BMJ. 2016;353:i2200. doi:https://doi.org/10.1136/bmj.i2200.

    Article  PubMed  PubMed Central  Google Scholar 

  51. HEDIS Measures and Technical Resources [Internet]. Washington, DC: National Committee for Quality Assurance [accessed 2022 Sept 8]. Available from: https://www.ncqa.org/hedis/measures/.

  52. Pogach L, Aron DC. Sudden acceleration of diabetes quality measures. JAMA. 2011;305(7):709-10. doi:https://doi.org/10.1001/jama.2011.153.

    Article  CAS  PubMed  Google Scholar 

  53. Caverly TJ, Fagerlin A, Zikmund-Fisher BJ, Kirsh S, Kullgren JT, Prenovost K, et al. Appropriate Prescribing for Patients With Diabetes at High Risk for Hypoglycemia: National Survey of Veterans Affairs Health Care Professionals. JAMA Intern Med. 2015;175(12):1994-6. doi:https://doi.org/10.1001/jamainternmed.2015.5950.

    Article  PubMed  Google Scholar 

  54. Pilla SJ, Segal JB, Maruthur NM. Primary Care Provides the Majority of Outpatient Care for Patients with Diabetes in the US: NAMCS 2009-2015. J Gen Intern Med. 2019;34(7):1089-91. doi:https://doi.org/10.1007/s11606-019-04843-9.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was funded by a grant from the U.S. Deprescribing Research Network, funded by the National Institute on Aging (1R24AG064025). Dr. Pilla was supported by the Johns Hopkins KL2 Clinical Research Scholars Program (KL2TR003099) and the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK128572). Dr. Schoenborn was supported by the National Institute on Aging (K76AG059984). Dr. Boyd was also supported by the U.S. Deprescribing Research Network (R24AG064025) and by K24AG056578, both from the National Institute on Aging. Dr. Mathioudakis was supported by the NIDDK (R01DK125780).

Author information

Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Scott J. Pilla MD, MHS, Rabia Jalalzai MD, MPH & Nisa M. Maruthur MD, MHS

  2. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

    Scott J. Pilla MD, MHS & Nisa M. Maruthur MD, MHS

  3. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Scott J. Pilla MD, MHS & Cynthia M. Boyd MD, MPH

  4. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Olive Tang MD, PhD, Cynthia M. Boyd MD, MPH & Nisa M. Maruthur MD, MHS

  5. Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nancy L. Schoenborn MD, MHS & Cynthia M. Boyd MD, MPH

  6. Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Michael P. Bancks PhD

  7. Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nestoras N. Mathioudakis MD, MHS

Authors
  1. Scott J. Pilla MD, MHS
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  2. Rabia Jalalzai MD, MPH
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  8. Nisa M. Maruthur MD, MHS
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Contributions

S.J.P contributed to the study design, data acquisition, analysis, and discussion, and wrote the manuscript. R.J. contributed to data acquisition and background research, and reviewed and edited the manuscript. N.L.S., C.M.B., N.N.M., and N.M.M. contributed to study design, analysis, and discussion, and reviewed and edited the manuscript. O.T. and M.P.B. contributed to analysis and discussion, and reviewed and edited the manuscript. All the authors approved the final version of the manuscript. S.J.P. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Scott J. Pilla MD, MHS.

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Conflict of Interest

Dr. Pilla received honoraria from the American Diabetes Association (ADA) for speaking at the ADA 2022 Scientific Sessions, the ADA 2023 Clinical Update Conference; for authoring the ADA Making Technology Work module on hypoglycemia; and for reviewing the ADA Diabetes Is Primary CE Certificate program. Dr. Boyd received honoraria for writing a chapter on Multiple Chronic Conditions for UpToDate, and a chapter on Falls in Older Adults for DynaMed.

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Pilla, S., Jalalzai, R., Tang, O. et al. A National Survey of Physicians’ Views on the Importance and Implementation of Deintensifying Diabetes Medications. J GEN INTERN MED 39, 992–1001 (2024). https://doi.org/10.1007/s11606-023-08506-8

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