Sei J Lee1, Irena Stijacic-Cenzer2, Caroline Barnhart2, Keelan McClymont2, Michael A Steinman2. 1. Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA. Electronic address: sei.lee@ucsf.edu. 2. Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Authors: Nihar R Desai; William H Shrank; Michael A Fischer; Jerry Avorn; Joshua N Liberman; Sebastian Schneeweiss; Juliana Pakes; Troyen A Brennan; Niteesh K Choudhry Journal: Am J Med Date: 2012-03 Impact factor: 4.965
Authors: Xinzhi Zhang; Frederic H Decker; Huabin Luo; Linda S Geiss; William S Pearson; Jinan B Saaddine; Edward W Gregg; Ann Albright Journal: J Am Geriatr Soc Date: 2010-04 Impact factor: 5.562
Authors: Sherrie L Aspinall; Xinhua Zhao; Chester B Good; Roslyn A Stone; Joy Boresi; Sarah Cox; Chad Bartholomew; David Jansen; Sarah Guterman; Mauricio Patino; Giselle Rivera-Miranda; Mark Burlingame; Justin Frazer; Janelle Sellers; Valerie Stanard Steele; Lauri Witt; Francesca E Cunningham Journal: Am J Geriatr Pharmacother Date: 2011-02
Authors: Silvio E Inzucchi; Richard M Bergenstal; John B Buse; Michaela Diamant; Ele Ferrannini; Michael Nauck; Anne L Peters; Apostolos Tsapas; Richard Wender; David R Matthews Journal: Diabetes Care Date: 2012-04-19 Impact factor: 19.112
Authors: Andrew R Zullo; David D Dore; Lori Daiello; Rosa R Baier; Roee Gutman; David R Gifford; Robert J Smith Journal: J Am Med Dir Assoc Date: 2016-03-24 Impact factor: 4.669
Authors: Sun Y Jeon; Ying Shi; Alexandra K Lee; Lauren Hunt; Kasia Lipska; John Boscardin; Sei Lee Journal: J Am Geriatr Soc Date: 2020-10-16 Impact factor: 5.562
Authors: Joshua D Niznik; Jacob N Hunnicutt; Xinhua Zhao; Maria K Mor; Florentina Sileanu; Sherrie L Aspinall; Sydney P Springer; Mary J Ersek; Walid F Gellad; Loren J Schleiden; Joseph T Hanlon; Joshua M Thorpe; Carolyn T Thorpe Journal: J Am Geriatr Soc Date: 2020-02-17 Impact factor: 5.562