(88) Impact of a diabetes deprescribing detailing initiative among commercially insured members

Background: : Dipeptidyl peptidase-4 (DPP4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are options for glycemic management in type 2 diabetes patients. These medications overlap in mechanism of action, both targeting the incretin pathway. Diabetes clinical guidelines do not include this combination in treatment recommendations. Blue Cross Blue Shield of Michigan (BCBSM) implemented a diabetes deprescribing academic detailing initiative targeting the GLP-1 and DPP4 combination to improve patient safety and enable cost savings.

Objective: : To assess proportion of GLP-1 and DPP4 combination use before vs. after prescriber academic detailing during 2022, 2023, and 2024.

Methods: : Retrospective study of commercial BCBSM pharmacy claims from 5/26/2021–8/31/2024. Included members were assigned by detailing year (DY): 2022, 2023, and 2024. Two pharmacists provided academic detailing by telephonic outreach to the provider office followed by a faxed report with a list of the practice’s identified members with opportunity for deprescribing. Members were excluded from analysis if they terminated pharmacy coverage prior to the assessment date for each evaluation year. Primary outcome evaluated was change in combination use within 7 months post-detailing start date. Inferred due to detailing was defined as final fill of discontinued medication was on or after detailing begin date of DY evaluated.

Results: : Total diabetes deprescribing opportunity targets were 651 members (DY 2022), 70 members (DY 2023), and 161 members (DY 2024). After applying exclusion criteria, total population evaluated was 547 members (DY 2022), 58 members (DY 2023), and 148 members (DY 2024). For DY 2022, 235 members continued combination therapy (43%), 75 members stopped both (13.7%), 237 members stopped one of the therapies (43.3%). For DY 2023, 4 members continued combination therapy (6.9%), 18 members stopped both (31%), 36 members stopped one of the therapies (62.1%). For DY 2024, 81 members continued combination therapy (54.7%), 11 members stopped both (7.4%), 56 members stopped one of the therapies (37.9%). Across each DY, stopping DPP4 only or GLP-1 only was inferred due to detailing for 80 members (33.8%, DY 2022 [n=237]), 9 members (25%, DY 2023 [n=36]), and 13 members (23.2%, DY 2024 [n=56]).

Conclusions: : Although the proportion of members who stopped either DPP4 or GLP-1 varied by DY, academic detailing remains a valuable strategy to deliver prescriber education to impact current and future diabetes deprescribing behaviors.

Sponsorship:: BCBSM