title: National Trends in Treatment Initiation for Nursing Home Residents With Diabetes Mellitus, 2008 to 2010.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Medicare Part D drug dispensing of glucose-lowering treatments; resident and facility characteristics preceding medication initiation.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI. Electronic address: andrew_zullo@brown.edu.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Zullo
authors.affiliation: Optum Epidemiology, Waltham, MA.
authors.forename: David D
authors.initials: DD
authors.lastname: Dore
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
authors.forename: Lori
authors.initials: L
authors.lastname: Daiello
authors.affiliation: 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.
authors.forename: Rosa R
authors.initials: RR
authors.lastname: Baier
authors.affiliation: Department of Biostatistics, School of Public Health, Brown University, Providence, RI.
authors.forename: Roee
authors.initials: R
authors.lastname: Gutman
authors.affiliation: Quality and Regulatory Affairs, American Health Care Association, Washington, DC.
authors.forename: David R
authors.initials: DR
authors.lastname: Gifford
authors.affiliation: 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.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D054524:Medicare Part D; D009735:Nursing Homes; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
keywords: Nursing home; diabetes; long-term care; pharmacotherapy; quality of care; treatment choice variation