Type 2 diabetes mellitus treatment patterns in US nursing home residents

Abstract

Background. The prevalence of type 2 diabetes mellitus (diabetes) in nursing home residents (NHRs) is increasing, concurrently with obesity and other comorbid conditions. NHR would benefit greatly from antidiabetic medications that would improve glycemic control and give a lower risk of hypoglycemia but that do not contribute to weight gain in obese individuals. Objective. To examine the prescription patterns to NHRs with diabetes, including the use of newer injectable therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists. Methods. Treatment patterns of diabetes in NHR were analyzed using Minimum Data Set records and prescription claims from the Omnicare Senior Health Outcomes data repository (May 2011–September 2012). Results. The prevalence of diabetes in this population of 229,283 NHRs was 35.4%. Among the 44,665 NHRs with diabetes and prescription claims data, the prevalence of obesity (40.3%) and multiple comorbidities (100%) was high. Approximately 20% of the NHRs with diabetes were aged <65 years. Overall, 20% of NHRs had diabetes that was untreated with medications during the study period. Insulin was the mainstay of treatment (>80%), followed by oral agents (54%). GLP-1 receptor agonist use was low (0.5%) and associated with poor treatment persistence. Conclusion. Considerations other than glycemic control may drive prescribing decisions, contrary to recommendations from the American Diabetes Association, American Medical Directors Association, and European Association for the Study of Diabetes.

Keywords :

• Type 2 diabetes
• insulin treatment
• elderly nursing home residents
• obesity
• prescription patterns
• minimum data set

Declaration of interest

Funding for this study was provided by Sanofi US, Inc. The authors received editorial and writing support in the preparation of this manuscript from Tessa Hartog, PhD, of Excerpta Medica, funded by Sanofi US, Inc. B Zarowitz, C Allen, and T O’Shea are employees of Omnicare Senior Health Outcomes, Inc., contracted on behalf of Sanofi. M Dalal and M Haumschild are employees of Sanofi. M Dalal is a stockholder of Sanofi and T O’Shea and B Zarowitz are stockholders of Omnicare. T O’Shea and B Zarowitz have received grant funding from Sanofi. A DiGenio was an employee of Sanofi at the time this study was performed and is currently an employee of Isis Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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