Patients More Reluctant to Discontinue Insulin Compared With Statins, Antihypertensives

Patients have a more positive attitude towards deprescribing statins and antihypertensives compared with sulfonylureas and insulins, according to findings from a survey published in Basic and Clinical Pharmacology and Toxicology. The authors stated that patients’ attitudes toward deprescribing differ by medication and it is important to understand to better inform practices.¹

“The appropriateness factor of the patients' attitudes towards deprescribing showed small but statistically significant differences across the specific medication classes for which the attitudes were assessed,” the study authors said.¹ “Patients perceived the appropriateness of their insulins higher than other medication classes.”

Medication optimization has many benefits for the patient, including improved health outcomes and lowering costs. Medication therapy management (MTM) has been the first widely adopted strategy for medication optimization. MTM includes a review of all prescribed medication as well as any OTC or herbal products the patient may be taking. Pharmacists often look for duplication medications, unnecessary medications, or a lack of medication for a conditions.^2,3

In a review published in American Health and Drug Benefits, MTM has limitations, so some practices have expanded the MTM steps into more advanced and holistic medication optimization. Although still referred to as MTM, it is often known as comprehensive medication management, which also includes the pharmacist working directly with patients and other members of the interdisciplinary patient care team.²

In the current study, investigators aimed to assess whether there were differences in older patients’ attitudes towards deprescribing cardiovascular and diabetes medications, including statins, antihypertensives, sulfonylureas, and insulins. As part of the study, all patients received clinical medication reviews. In the Netherlands, where the study was conducted, it is common practice that community pharmacists and general practitioners conduct reviews for older patients and for polypharmacy. The primary outcome included scores for the medication-specific appropriateness as well as concern factors.¹

There were 310 patients included in the study, but the questionnaire containing medication-specific revised Patients’ Attitudes Towards Deprescribing (rPATD) was not administered to 17 patients, and the medication reviews were never scheduled for 12 patients. Further, 10 patients did not use any of the medications of interest, and phone interviews failed for 5 patients. In total, 280 patients were included in the final analysis.¹

Approximately 87% of patients agreed that they would be willing to discontinue 1 or more of their medications if their physician said it was okay. However, 45% of patients said they were comfortable with a community pharmacist saying it, with an additional 20% being neutral about it. For 160 patients, they were taking 2 or more of the medications of interest. Their willingness to stop taking medication was approximately 90% for those who were told to stop by a physician and 45% if they were told by their pharmacist.¹

“Often, health care providers need to convince patients with type 2 diabetes to initiate insulin, supporting the belief that insulin cannot be stopped,” the study authors said. “The regular monitoring of glucose levels after insulin initiation might strengthen the belief that a patient needs continuous use of the insulin.”

For appropriateness, investigators found no significant difference between statins and multiple antihypertensives. However, the appropriateness for insulin was higher compared with all other medication classes. Compared with statins and antihypertensives, the appropriateness score was also higher for sulfonylureas. For stopping insulin, only 20% of patients were positive about discontinuing the medication compared with 37% taking sulfonylureas, 44% taking antihypertensives, and 48% taking statins. Approximately 78% of patients taking insulin were worried about missing out on future benefits compared with 61% taking sulfonylureas, 53% taking antihypertensives, and 49% taking statins.¹

“The observed differences in perceived appropriateness between the medication classes could also be related to both differences in a patient’s ability to perceive (short‐term) effectiveness of the drug used and the perceived severity of disease,” the study authors said.¹

READ MORE: Insulin Management Resource Center

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REFERENCES

1. Stuijt PJC, Crutzen S, Heringa M, et al. Patients' Attitudes Towards Deprescribing Differ Across Specific Cardiovascular and Diabetes Medication: A Survey Study Assessing Within-Patient Differences. Basic Clin Pharmacol Toxicol. 2025;137(6):e70140. doi:10.1111/bcpt.70140

2. McFarland MS, Finks SW, Smith L, et al. Medication Optimization: Integration of Comprehensive Medication Management into Practice. Am Health Drug Benefits. 2021;14(3):111-114.

3. American College of Clinical Pharmacy. What is medication therapy management. Accessed November 19, 2025. https://www.accp.com/docs/govt/advocacy/Leadership%20for%20Medication%20Management%20-%20MTM%20101.pdf