Andrew R Zullo1, David D Dore2, Lori Daiello3, Rosa R Baier4, Roee Gutman5, David R Gifford6, Robert J Smith7. 1. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI. Electronic address: andrew_zullo@brown.edu. 2. Optum Epidemiology, Waltham, MA. 3. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI. 4. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Center for Long-Term Care Quality and Innovation, School of Public Health, Brown University, Providence, RI. 5. Department of Biostatistics, School of Public Health, Brown University, Providence, RI. 6. Quality and Regulatory Affairs, American Health Care Association, Washington, DC. 7. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI; Department of Medicine, Alpert Medical School, Brown University, Providence, RI.
Abstract
OBJECTIVE: Diabetes mellitus is common in the nursing home (NH) population, yet little is known about prescribing of glucose-lowering medications in the NH setting. We describe trends in initiation of glucose-lowering medications in a national cohort of NH residents. DESIGN AND SETTING: Retrospective cohort study using Part A and D claims for a random 20% of Medicare enrollees linked to NH Minimum Data Set (MDS) and Online Survey, Certification, and Reporting (OSCAR) databases in 7158 US NHs. PARTICIPANTS: A total of 11,531 long-stay (continuous residence of ≥90 days) NH residents 65 years or older with diabetes who received a glucose-lowering medication between 2008 and 2010 after 4 months of nonuse. MEASUREMENTS: Medicare Part D drug dispensing of glucose-lowering treatments; resident and facility characteristics preceding medication initiation. RESULTS: We observed decreasing sulfonylurea initiation from 25.4% of initiations in 2008 to 11.7% in 2010, an average decrease of 1% per quarter (95% CLs -1.5 to -0.5). Thiazolidinedione initiation decreased from 4.7% to 1.9%, an average decrease of 0.3% per quarter (95% CLs -0.4 to -0.2), and meglitinide initiation from 1.5% to 0.3%. No appreciable linear trends were observed for metformin (range 12.0%-18.8%) and dipeptidyl peptidase-4 (DPP-4) inhibitors (range 0.9%-2.7%). In contrast, insulin use increased from 51.7% to 68.3% during the same time period, driven by a marked increase in initiation of rapid-acting insulin (11.0% to 29.4%; average increase of 1.4% per quarter, 95% CLs 0.9-1.9) and a modest increase in short-acting insulin (22.6% to 30.3%; an average increase of 0.6% per quarter, 95% CLs -0.1 to 1.3). CONCLUSIONS: Between 2008 and 2010, there were substantial decreases in the use of oral glucose-lowering agents and corresponding increases in the use of insulin among long-term residents of US NHs.
OBJECTIVE:Diabetes mellitus is common in the nursing home (NH) population, yet little is known about prescribing of glucose-lowering medications in the NH setting. We describe trends in initiation of glucose-lowering medications in a national cohort of NH residents. DESIGN AND SETTING: Retrospective cohort study using Part A and D claims for a random 20% of Medicare enrollees linked to NH Minimum Data Set (MDS) and Online Survey, Certification, and Reporting (OSCAR) databases in 7158 US NHs. PARTICIPANTS: A total of 11,531 long-stay (continuous residence of ≥90 days) NH residents 65 years or older with diabetes who received a glucose-lowering medication between 2008 and 2010 after 4 months of nonuse. MEASUREMENTS: Medicare Part D drug dispensing of glucose-lowering treatments; resident and facility characteristics preceding medication initiation. RESULTS: We observed decreasing sulfonylurea initiation from 25.4% of initiations in 2008 to 11.7% in 2010, an average decrease of 1% per quarter (95% CLs -1.5 to -0.5). Thiazolidinedione initiation decreased from 4.7% to 1.9%, an average decrease of 0.3% per quarter (95% CLs -0.4 to -0.2), and meglitinide initiation from 1.5% to 0.3%. No appreciable linear trends were observed for metformin (range 12.0%-18.8%) and dipeptidyl peptidase-4 (DPP-4) inhibitors (range 0.9%-2.7%). In contrast, insulin use increased from 51.7% to 68.3% during the same time period, driven by a marked increase in initiation of rapid-acting insulin (11.0% to 29.4%; average increase of 1.4% per quarter, 95% CLs 0.9-1.9) and a modest increase in short-acting insulin (22.6% to 30.3%; an average increase of 0.6% per quarter, 95% CLs -0.1 to 1.3). CONCLUSIONS: Between 2008 and 2010, there were substantial decreases in the use of oral glucose-lowering agents and corresponding increases in the use of insulin among long-term residents of US NHs.
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