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

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• 作者：Andrew R. Zullo ; PharmD ; ScM^a ; ^{andrew_zullo@brown.edu" class="auth_mail" title="E-mail the corresponding author} ; David D. Dore ; PharmD ; PhD^b ; Lori Daiello ; PharmD ; ScM^a ; Rosa R. Baier ; MPH^a ; ^c ; Roee Gutman ; PhD^d ; David R. Gifford ; MD ; MPH^e ; Robert J. Smith ; MD^a ; ^f
• 关键词：Nursing home ; diabetes ; long-term care ; pharmacotherapy ; treatment choice variation ; quality of care
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 July 2016
• 年：2016
• 卷：17
• 期：7
• 页码：602-608
• 全文大小：967 K

文摘

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.