PSHP 2026 Residency Conference

Purpose:
Sulfonylureas (SU) increase risks of hypoglycemia, weight gain, and uncertain long‑term glycemic control. This project evaluates how Clinical Pharmacy Practitioners (CPPs) improve diabetes care by deprescribing SUs and optimizing therapy.
 
Methods:
Patients were identified from a CMCVAMC report of those with an active SU prescription or via provider referral. CPPs then conducted comprehensive medication management visits to assess therapy and optimize diabetes care when appropriate. The primary outcome was the change in reported hypoglycemia before and after CPP interventions. Secondary outcomes included changes to preferred agents, A1c, and weight. Patients were included if they are ≥60 years old, have an A1c ≤10.5%, have an active VA or non‑VA prescription for glipizide, glimepiride, or glyburide, and were identified as at risk for adverse outcomes from SU use. A follow‑up assessment of SU use occurred with the CPP or Primary Care Physician (PCP) at least once. Patients were excluded if they receive hospice care, are under 60 years old, or have an A1c >10.5%.
 
Results:
The population was predominantly male and white, with 41.9% having baseline CKD and 51.2% having ASCVD. Most participants were overweight or obese. All patients (100%) were initially receiving a SU, alongside varying use of metformin, SGLT2 inhibitors, DPP‑4 inhibitors, GLP‑1 agents, and insulin therapies. Hypoglycemia was reported by 32.6% at baseline and after interventions the incidence declined to 7.4%. Following CPP review, 51.8% had the SU discontinued, 12.9% had dose reduction, and 10.6% were instructed to take the medication before meals, while 27.1% had no intervention. The final regimen demonstrated shifts toward metformin (63.4%), SGLT2 inhibitors (64.6%), and GLP‑1 agents (25.6%), with SU use decreasing to 41.5%.


Conclusion:
Interventions targeting SU therapy led to regimen optimization and a reduction in hypoglycemia. Increased uptake of metformin, SGLT2 inhibitors, and GLP‑1 therapies reflects improved safety and closer adherence to guideline‑preferred treatments, highlighting the value of proactive medication review performed by CPPs.