Implementing physician-led medication reviews for patients with diabetes and severe mental disorder: A randomized controlled trial

Aims: Patients with severe mental disorder and diabetes may be exposed to inappropriate polypharmacy increasing the risk of side effects and drug interactions. Although medication reviews may facilitate short-term deprescribing, they are not known to affect clinical outcomes. We investigated whether implementing physician-led medication reviews through interdisciplinary dialogue can change prescription patterns and improve pharmacological efficacy and tolerability in psychiatric outpatients with diabetes. Methods: Included in the study were 52 patients from an endocrinologist–psychiatrist outpatient clinic in Slagelse Region, Zealand, Denmark. Patients were allocated to an intervention group, where patients' pharmacological treatment was discussed at an interdisciplinary treatment conference based on a medication review conducted by a specialist in clinical pharmacology or a control group receiving standard care. All patients underwent psychometric testing, side effect screening, clinical interviews, and had drug regimens and biochemical test results extracted from the electronic health records at baseline and at 6 months follow up. Results: The trial was completed by 48 patients. Average time to follow up was 7 months (range 5–11 months). The intervention group had a median reduction of 1 drug (interquartile range [IQR] −4.00, 0.00) and 1 potentially inappropriate prescription (IQR –2.00, 0.00) compared to a median increase of 2 drugs (IQR 1.00, 3.00) and 2 potentially inappropriate prescriptions (IQR 0.00, 3.00) in the control group. The usage of both somatic and psychiatric drugs was reduced. We found no differences in clinical outcomes. Conclusion: Deprescribing can be achieved without worsening psychiatric symptoms in psychiatric outpatients by implementing physician-led medication reviews through interdisciplinary dialogue. This study was registered on ClinicalTrials.gov: NCT (05243160).