Deprescribing in Elderly Diabetes: Integrating Clinical Practice with Vedantic Wisdom

Background: The growing burden of type 2 diabetes (T2D) in older adults, particularly in low-and middle-income countries like India, has intensified concerns around polypharmacy, adverse drug events, and inappropriate prescribing. Age-related physiological changes and multimorbidity complicate diabetes management in late life, necessitating a shift from disease-centric intensification toward rational, patient-centered deprescribing. Objective: This narrative review synthesizes current evidence on the clinical, ethical, and cultural dimensions of deprescribing in older adults with T2D, with an emphasis on the Indian context. It proposes the Clinical Pharmacological Reconciliation, Review, and Feedback (CPRRF) model as a structured framework for safe and individualized deprescribing. Methods: Drawing from empirical studies, clinical pharmacology principles, and cultural-philosophical insights, this review integrates international and Indian data on polypharmacy-related risks, deprescribing strategies, and health system challenges. The Monitoring, Instructions, Start-low/Go-slow, Omission (MISO) model, an India-specific tool developed at the Institute of Medical Sciences, Banaras Hindu University, is also discussed as a contextually adapted deprescribing protocol. Results: Polypharmacy affects up to 49% of elderly Indian adults, with adverse drug reactions accounting for nearly 10% of hospitalizations – many of them preventable. Deprescribing is associated with improved safety, preserved cognitive and functional capacity, enhanced adherence, reduced financial burden, and ethical alignment with late-life care goals. The proposed CPRRF model incorporates ten actionable steps, including medication review, affordability analysis, and individualized goal setting. A clinical vignette demonstrates the model’s real-world application. In addition, deprescribing may also be culturally resonant in settings where traditions emphasizing discernment, restraint, and ethical care inform health-related decision-making. Conclusion: Deprescribing in geriatric T2D care is both a clinical and moral imperative, especially in resource-constrained and culturally diverse settings. Structured approaches such as the CPRRF and MISO models promote safer, more ethical, and context-sensitive prescribing. By prioritizing patient autonomy, functionality, and dignity, deprescribing shifts the clinical paradigm from “doing more” to “doing wisely,” enabling care that heals through intentional restraint.