Evidence map›Paper›PMID 29138153›Full record

GuidelineCanadian family physician Medecin de famille canadien2017

Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline.

Barbara Farrell, Cody Black, Wade Thompson, Lisa McCarthy, Carlos Rojas-Fernandez, Heather Lochnan, Salima Shamji, Ross Upshur, Manon Bouchard, Vivian Welch

Registry-linked trialAbstract readPractice Guideline
PubMed Full text at PMC
In one paragraph

Guideline in Canadian family physician Medecin de famille canadien, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03689049 (SPIDER), which is not on this map. Cited by 80 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
80citing papers in PubMed, 2 pooled it
15.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03689049 naactive not recruitingnot on this mapstarted 2018, after this paper: background citation

SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients

TypeinterventionalSponsorUniversity of Toronto Practice Based Research NetworkRan2018 to 2027Enrolled104ConditionsPolypharmacy, Inappropriate Prescribing, Aged, Primary Health CareArmsSPIDER, Usual Care
3 · Its place in the literature

Who cites it

80 citing papers in PubMed, 2 syntheses or guidelines pooled it, 145 citations in OpenAlex.

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  17. [Why represcribing instead of deprescribing?]Innere Medizin (Heidelberg, Germany) · 2026
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  20. Review

20 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Barbara FarrellScientist at the Bruyère Research Institute and C.T. Lamont Primary Health Care Research Centre, Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, and Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario. bfarrell@bruyere.org.
Cody BlackResearch Coordinator at the Bruyère Research Institute.
Wade ThompsonResearch Coordinator at the Bruyère Research Institute and a master's candidate in the School of Epidemiology, Public Health and Preventive Medicine at the University of Ottawa.
Lisa McCarthyAssistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario and a pharmacy scientist at Women's College Hospital Research Institute.
Carlos Rojas-FernandezAssistant Professor in the School of Pharmacy and the School of Public Health and Health Systems at the University of Waterloo and Schlegel Research Chair in Geriatric Pharmacotherapy at the Schlegel-University of Waterloo Research Institute on Ageing.
Heather LochnanAssociate Professor of Medicine at the University of Ottawa and is an endocrinologist at the Ottawa Hospital.
Salima ShamjiAssistant Professor in the Department of Family Medicine at the University of Ottawa.
Ross UpshurProfessor in the Dalla Lana School of Public Health at the University of Toronto.
Manon BouchardNurse practitioner with the Bruyère Academic Family Health Team.
Vivian WelchAssistant Professor in the School of Epidemiology, Public Health and Preventive Medicine, Deputy Director of the Centre for Global Health at the University of Ottawa, and a clinical epidemiology methodologist at the Bruyère Research Institute.
University of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper, stop, or switch antihyperglycemic agents in older adults.

methodsWe focused on the highest level of evidence available and sought input from primary care professionals in guideline development, review, and endorsement processes. Seven clinicians (2 family physicians, 3 pharmacists, 1 nurse practitioner, and 1 endocrinologist) and a methodologist comprised the overall team; members disclosed conflicts of interest. We used a rigorous process, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, for guideline development. We conducted a systematic review to assess evidence for the benefits and harms of deprescribing antihyperglycemic agents. We performed a review of reviews of the harms of continued antihyperglycemic medication use, and narrative syntheses of patient preferences and resource implications. We used these syntheses and GRADE quality-of-evidence ratings to generate recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and stakeholders for review and revisions were made at each stage. A decision-support algorithm was developed to accompany the guideline. RECOMMENDATIONS: We recommend deprescribing antihyperglycemic medications known to contribute to hypoglycemia in older adults at risk or in situations where antihyperglycemic medications might be causing other adverse effects, and individualizing targets and deprescribing accordingly for those who are frail, have dementia, or have a limited life expectancy.

conclusionThis guideline provides practical recommendations for making decisions about deprescribing antihyperglycemic agents. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.

Indexed as

DeprescriptionsAgedConsensusDementiaDrug-Related Side Effects and Adverse ReactionsEvidence-Based MedicineHumansHyperglycemiaHypoglycemic AgentsPrimary Health CareHypoglycemic Agents

Identifiers

PMID29138153
PMCPMC5685444
OpenAlexW2902708442

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.