National Trends in Treatment Initiation for Nursing Home Residents With Diabetes Mellitus, 2008 to 2010

Andrew R Zullo; David D Dore; Lori Daiello; Rosa R Baier; Roee Gutman; David R Gifford; Robert J Smith

doi:10.1016/j.jamda.2016.02.023

National Trends in Treatment Initiation for Nursing Home Residents With Diabetes Mellitus, 2008 to 2010

J Am Med Dir Assoc. 2016 Jul 1;17(7):602-8. doi: 10.1016/j.jamda.2016.02.023. Epub 2016 Mar 24.

Authors

Andrew R Zullo¹, David D Dore², Lori Daiello³, Rosa R Baier⁴, Roee Gutman⁵, David R Gifford⁶, Robert J Smith⁷

Affiliations

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.

Keywords: Nursing home; diabetes; long-term care; pharmacotherapy; quality of care; treatment choice variation.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Aged
Aged, 80 and over
Diabetes Mellitus / drug therapy*
Female
Humans
Insurance Claim Reporting
Male
Medicare Part D
Nursing Homes*
Quality of Health Care
Retrospective Studies
Time Factors
United States

Grants and funding

K12 HS022998/HS/AHRQ HHS/United States