Is It the Right Time to Deprescribe This Frail Patient's Metformin?

Charles P. Vega, MD


May 20, 2021

In this edition of Cases in Deprescribing, I present another clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments, particularly if you disagree with me.

You are seeing an 81-year-old woman for a routine follow-up visit. Her medical history is significant for the following:

  • Type 2 diabetes lasting more than 20 years, with albuminuria

  • Chronic kidney disease stage 3 with an estimated glomerular filtration rate (eGFR) of 47 mL/min

  • Hypertension

  • Cerebrovascular accident 4 years ago

  • Obesity

  • Mild Alzheimer's disease, diagnosed last year

She has no complaints at today's visit besides an achy knee. She reports that she performs home glucose testing several times per week while fasting, with values between 90 and 110 mg/dL. Her appetite and body weight are stable, and her A1c last week was 7.5%.

The patient is taking a total of six medications chronically, but her only medication for diabetes management at this time is metformin 500 mg twice daily. Her daughter is linking into the visit via telehealth and requests that her overall medication count be minimized to improve adherence. The daughter helps her mother manage her medications on a weekly basis, but she notices that the patient is struggling more over the past month to adhere to her medication regimen.


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