Changing Patterns of Glucose-Lowering Medication Use in VA Nursing Home Residents With Diabetes, 2005 to 2011.
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.


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
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.
Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA. Electronic address: sei.lee@ucsf.edu.
Sei J
SJ
Lee
Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA.
Irena
I
Stijacic-Cenzer
Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA.
Caroline
C
Barnhart
Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA.
Keelan
K
McClymont
Division of Geriatrics, San Francisco VA and University of California San Francisco, San Francisco, CA.
Michael A
MA
Steinman
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D005905:Glyburide / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D009735:Nursing Homes; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin; C089946:2,4-thiazolidinedione; D005905:Glyburide
Nursing home; diabetes; glucose-lowering; insulin; metformin