A patient request for some “deprescribing”:

Abstract

A 52 year old man with a history of type 2 diabetes for 14 years and hypertension for nine years presented to his general practitioner. He was a non-smoker with an alcohol intake of eight units a week. He had been experiencing bloating, abdominal pains, and erratic motions for more than a year. Because he drove about 12 000 miles a year for his job he found the loose motions "a real worry." He wondered whether any of his problems might be caused by his drugs and asked if he could cut down on any if they weren't all needed. He admitted to being afraid that his diabetic control might deteriorate and that he might need insulin, like some of his relatives who also had diabetes.He was taking aspirin 75 mg once daily, metformin 500 mg three times daily, perindopril 4 mg daily, and simvastatin 40 mg at night.On examination his weight was 108.8 kg (steady at this for 10 years), body mass index was 34.4, waist circumference was 113 cm, and his blood pressure was 130/80 mm Hg (steady at this level for some years). His abdominal examination was normal, except that he had central obesity.Glycated haemoglobin (HbA 1c ) was 52 mmol/mol (reference range 0-41), bilirubin was 7 µmol/L (0-20), alanine aminotransferase was 53 U/L (5-37), and γ-glutamyl transferase (GGT) was 59 U/L (0-50). In addition, his estimated glomerular filtration rate was 100 mL/min/1.73m 2 (90-120), total cholesterol was 3.7 mmol/L (desirable ≤4.0), high density lipoprotein-cholesterol was 1.3 mmol/L (>1.0), and triglycerides were 1.3 mmol/L (<1.7). Questions

Can Diet Help Non-Obese Individuals with Non-Alcoholic Fatty Liver Disease (NAFLD)?

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“…A case review by Unwin and Tobin 8 documented that they were able to ‘deprescribe’ a 52-year-old man who was living with T2D for 14 years. He was suffering from gastrointestinal side effects from his metformin medication.…”

“…Following a low-carbohydrate diet, the patient steadily lost a total of 16 kg over 7 months and successfully stopped all prescribed drugs, thereby achieving his goal of being medication-free. 8 …”

Bridging the gap between science-led research and evaluation of clinical practice: the role of service innovation audits and case studies

“…Showcasing n=1 cases may also provide motivation to colleagues, helping them to challenge preconceived ideas and consider the difference between research and clinical practice, then to think through and apply similar approaches to help their own patients-ultimately leading to better practice. 4 However, these views are not dichotomous, but complementary, whereby practice should inform science and science should inform practice.…”