Patients More Reluctant to Discontinue Insulin Than Statins, Antihypertensives

Patients have a more positive attitude toward 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 essential to understand these attitudes to better inform practices.¹

“The appropriateness factor of the patients' attitudes toward 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 [as being] higher than other medication classes.”

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

According to review findings 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 toward 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 for community pharmacists and general practitioners to conduct reviews for older patients and those with polypharmacy. The primary outcome included scores for the medication-specific appropriateness as well as concern factors.¹

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

Approximately 87% of patients agreed they would be willing to discontinue 1 or more of their medications if their physician were amenable. However, 45% of patients said they were comfortable with a community pharmacist saying it, with an additional 20% being neutral about it. One hundred sixty patients were taking 2 or more of the medications of interest. Approximately 90% of patients were willing to stop taking their medication if instructed to do so by a physician, and 45% were willing to do so if their pharmacist recommended it.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, appropriateness for insulin was higher than 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 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, Buck ML, Ourth H, Brummel A; Medications Right Institute. Medication optimization: integration of comprehensive medication management into practice. Am Health Drug Benefits. 2021;14(3):111-114.

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