Can You Discontinue a Diabetes Medication with an A1c of 5.2?
Yes, you should strongly consider deintensifying your diabetes regimen by discontinuing or reducing one of your oral medications, as your A1c of 5.2% is well below the recommended target and puts you at risk for hypoglycemia and other treatment-related harms without additional clinical benefit. 1
Evidence for Deintensification at A1c <6.5%
The American College of Physicians explicitly recommends deintensifying pharmacologic therapy when A1c levels fall below 6.5%, as no trials demonstrate clinical outcome benefits at this level, and treatment below this threshold is associated with substantial harms including hypoglycemia, increased mortality risk, and unnecessary treatment burden. 1
The ACCORD trial, which targeted A1c levels below 6.5%, was discontinued early due to increased overall and cardiovascular-related deaths and severe hypoglycemic events, demonstrating the dangers of overly aggressive glycemic control. 1
Which Medication to Discontinue
Discontinue Janumet (sitagliptin/metformin combination) first, as the DPP-4 inhibitor component provides the least glycemic benefit compared to your other agents:
Metformin reduces A1c approximately 0.43% more than DPP-4 inhibitors (sitagliptin), making the DPP-4 component the weakest glucose-lowering agent in your regimen. 1
Jardiance (empagliflozin) should be continued regardless of A1c level because SGLT-2 inhibitors provide cardiovascular and renal benefits independent of glucose lowering, particularly valuable if you have or are at risk for cardiovascular disease, heart failure, or chronic kidney disease. 1
The 2024 American Diabetes Association Standards recommend introducing or maintaining SGLT-2 inhibitors in patients with cardiovascular disease at A1c goal for cardiovascular benefit, independent of baseline A1c or individualized A1c goal. 1
Practical Deintensification Strategy
Step 1: Discontinue Janumet entirely (both the sitagliptin and metformin components), as you're already on Mounjaro (tirzepatide), which is a highly potent GLP-1/GIP receptor agonist that provides superior glycemic control. 1
Step 2: Continue Jardiance 25 mg for its cardioprotective and renoprotective benefits that extend beyond glucose lowering. 1
Step 3: Reassess A1c in 3 months:
- If A1c remains <7%, continue current simplified regimen
- If A1c rises to 7-8%, this represents appropriate glycemic control without overtreatment 1
- Only consider adding back medication if A1c exceeds 8% 1
Important Caveats
Mounjaro (tirzepatide) alone is likely sufficient for your glucose control given your current A1c of 5.2%, and the combination with Jardiance provides optimal cardiovascular/renal protection while maintaining adequate glycemic control.
Avoid the common pitfall of "therapeutic inertia in reverse" - healthcare providers often hesitate to reduce medications even when clearly indicated, but continuing unnecessary treatment at your A1c level causes more harm than benefit. 1
The target A1c range of 7-8% is appropriate for most adults with type 2 diabetes, balancing microvascular risk reduction against treatment harms, with more relaxed targets (avoiding symptoms rather than targeting specific A1c) appropriate for those with limited life expectancy or multiple comorbidities. 1