Abstract
Objective
Although nursing home (NH) residents make up a large and growing proportion of Americans
with diabetes mellitus, little is known about how glucose-lowering medications are
used in this population. We sought to examine glucose-lowering medication use in Veterans
Affairs (VA) NH residents with diabetes between 2005 and 2011.
Research Design and Methods
Retrospective cohort study, using linked laboratory, pharmacy, administrative, and
NH Minimum Dataset (MDS) 2.0 databases in 123 VA NHs. A total of 9431 long-stay (>90 days)
VA NH residents older than 65 followed for 52,313 person-quarters. We identified receipt
of glucose-lowering medications, including insulin, metformin, sulfonylureas, thiazolidinediones,
and others (alpha-glucosidase inhibitors, meglitinides, glucagonlike peptide-1 analogs,
dipeptidyl peptidase-4 inhibitors and amylin analogs) per quarter.
Results
The rates of sulfonylurea use in long-stay NH residents dropped dramatically from
24% in 2005 to 12% in 2011 (P < .001), driven in large part by the dramatic decrease in glyburide use (10% to 2%,
P < .001). There was sharp drop in thiazolidinedione use in 2007 (4% to <1%, P < .001). Metformin use was stable, ranging between 7% and 9% (P = .24). Insulin use increased slightly from 30% to 32% (P < .001). Use of other classes of glucose-lowering medications was stable (P = .22) and low, remaining below 1.3%.
Conclusions and Relevance
Between 2005 and 2011, there were dramatic declines in use of sulfonylureas and thiazolidinediones
in VA NH residents, suggesting that prescribing practices can be quickly changed in
this setting.
Keywords
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References
- Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004.J Am Geriatr Soc. 2010; 58: 724-730
- Diabetes in U.S. nursing homes, 2004.Diabetes Care. 2008; 31: 287-288
- Projection of the year 2050 burden of diabetes in the US adult population: Dynamic modeling of incidence, mortality, and prediabetes prevalence.Popul Health Metr. 2010; 8: 29
- Rates of complications and mortality in older patients with diabetes mellitus: The diabetes and aging study.JAMA Intern Med. 2014; 174: 251-258
- The application of evidence-based principles of care in older persons (issue 3): Management of diabetes mellitus.J Am Med Dir Assoc. 2006; 7: 234-240
- Status of diabetes management in the nursing home setting in 2008: A retrospective chart review and epidemiology study of diabetic nursing home residents and nursing home initiatives in diabetes management.J Am Med Dir Assoc. 2009; 10: 354-360
- Standards of medical care in diabetes—2007.Diabetes Care. 2007; 30: S4-S41
- Regulatory action on rosiglitazone by the U.S. Food and Drug Administration.N Engl J Med. 2010; 363: 1489-1491
- Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes.N Engl J Med. 2007; 356: 2457-2471
- FDA places “black box” warning on antidiabetes drugs.BMJ. 2007; 334: 1237
- Effects of intensive glucose lowering in type 2 diabetes.N Engl J Med. 2008; 358: 2545-2559
- Goals of glycemic control in frail older patients with diabetes.JAMA. 2011; 305: 1350-1351
- Management of hyperglycemia in type 2 diabetes: A patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).Diabetes Care. 2012; 35: 1364-1379
- Diabetes in older adults.Diabetes Care. 2012; 35: 2650-2664
- Standards of medical care in diabetes—2014.Diabetes Care. 2014; 37: S14-S80
- Pharmacy data in the VA health care system.Med Care Res Rev. 2003; 60: 92S-123S
- The work of the RN Minimum Data Set coordinator in its organizational context.Res Gerontol Nurs. 2008; 1: 42-51
- Multiple imputation: A primer.Stat Methods Med Res. 1999; 8: 3-15
- Multiple imputation using chained equations: Issues and guidance for practice.Stat Med. 2011; 30: 377-399
- Scaling ADLs within the MDS.J Gerontol A Biol Sci Med Sci. 1999; 54: M546-M553
- Functional status of elderly adults before and after initiation of dialysis.N Engl J Med. 2009; 361: 1539-1547
- Patterns of medication initiation in newly diagnosed diabetes mellitus: Quality and cost implications.Am J Med. 2012; 125: 302.e1-302.e7
- American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults.J Am Geriatr Soc. 2012; 60: 616-631
- Rates of hypoglycemia in users of sulfonylureas.J Clin Epidemiol. 1997; 50: 735-741
- Individual sulfonylureas and serious hypoglycemia in older people.J Am Geriatr Soc. 1996; 44: 751-755
- Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.Diabetes Care. 2006; 29: 1963-1972
- Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes.Diabetes Care. 2009; 32: 193-203
- Intervention to decrease glyburide use in elderly patients with renal insufficiency.Am J Geriatr Pharmacother. 2011; 9: 58-68
- A study of the effects of hypoglycemia agents on vascular complications in patients with adult-onset diabetes. VI. Supplementary report on nonfatal events in patients treated with tolbutamide.Diabetes. 1976; 25: 1129-1153
- Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction.J Am Coll Cardiol. 1999; 33: 119-124
- Dose-response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: A population-based cohort study.CMAJ. 2006; 174: 169-174
- Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: A nationwide study.Eur Heart J. 2011; 32: 1900-1908
- American Association of Clinical Endocrinologists' comprehensive diabetes management algorithm 2013 consensus statement—executive summary.Endocr Pract. 2013; 19: 536-557
- The 2013 American Association of Clinical Endocrinologists' diabetes mellitus management recommendations: Improvements needed.JAMA Intern Med. 2014; 174: 179-180
- 6 EZ steps to improving your performance: (or how to make P4P pay 4U!).JAMA. 2008; 300: 255-256
- Trends of insulin use among US adults with type 2 diabetes: The Behavioral Risk Factor Surveillance System, 1995–2007.J Diabet Complications. 2012; 26: 17-22
Age-Adjusted Percentage of Adults with Diabetes Using Diabetes Medication, by Type of Medication, United States, 1997-2011. Nov 19, 2013. Available at: http://www.cdc.gov/diabetes/statistics/meduse/fig2.htm. Accessed June 24, 2015
Article info
Publication history
Published online: August 10, 2015
Footnotes
The authors declare no conflicts of interest.
This work was supported with resources from and the use of facilities at the San Francisco VA Medical Center. S.J.L was supported by the Beeson Career Development program from the National Institute on Aging (K23AG040779) and the American Federation of Aging Research. M.A.S was supported by the National Heart, Lung, and Blood Institute (R01HL111032).
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Published by Elsevier Inc.
