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Multicenter Study
. 2019 May;67(5):1066-1073.
doi: 10.1111/jgs.15790. Epub 2019 Jan 31.

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Scott J Pilla  1 , Jodi B Segal  1   2   3   4   5 , G Caleb Alexander  1   2   3   4 , Cynthia M Boyd  2   3   6 , Nisa M Maruthur  1   2   5
Affiliations
Multicenter Study

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Scott J Pilla et al. J Am Geriatr Soc. 2019 May.

Abstract

Background/objectives: The treatment of type 2 diabetes in older adults requires special considerations including avoidance of hypoglycemia, yet variation in diabetes treatment with aging is not well understood. In this study, we compared nationally representative diabetes treatment patterns and trends between older adults (≥65 y) and younger adults (30-64 y).

Design: Repeated cross-sectional physician surveys from 2006 to 2015.

Setting: The National Ambulatory Medical Care Survey, an annual probability sample of visits to office-based US physicians.

Participants: Adults with type 2 diabetes using one or more diabetes medications.

Measurements: Proportions of visits in which patients treated with each diabetes medication class were compared between older and younger adults in 2-year intervals.

Results: From 2006 to 2015, the average number of yearly visits for older and younger adults was 25.4 million and 24.2 million, respectively. In 2014-2015, visits for older compared with younger adults involved less use of metformin (56.0% vs 70.0%; p < .001) and glucagon-like peptide 1 receptor agonists (2.9% vs 6.2%; p = .004), and more use of long-acting insulin (30.2% vs 22.4%; p = .017); other classes were used similarly. During the study period, long-acting insulin use increased markedly in older adults, particularly between 2010 and 2015 where it rose from 12.5% to 30.2% of visits (P-trend <.001). In younger adult visits, long-acting insulin use increased modestly (17.2% to 22.4%) and at a slower rate compared with older adult visits (p < .001).

Conclusion: The ambulatory treatment of type 2 diabetes differs between older and younger adults, with the treatment of older adults characterized by low use of newer diabetes medications and a greater and rapidly increasing use of long-acting insulin. These findings call for further research clarifying the comparative effectiveness and safety of newer diabetes medications and long-acting insulin to optimize diabetes care for older patients. J Am Geriatr Soc 67:1066-1073, 2019.

Keywords: age groups; aged; diabetes mellitus, type 2/drug therapy; diabetes mellitus, type 2/epidemiology; drug utilization.

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Conflict of interest statement

Conflict of Interest: Cynthia M. Boyd is a coauthor for a chapter on multimorbidity for UpToDate. G. Caleb Alexander is chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, has served as a paid advisor to IQVIA, serves on the advisory board of MesaRx Innovations, is a member of OptumRx’s National P&T Committee, and holds equity in Monument Analytics, a healthcare consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation. This arrangement was reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The remaining authors have no other relevant relationships to declare.

Figures

Figure 1.
Figure 1.
Trends in noninsulin diabetes medications used in treated diabetes visits by age, 2006–2015. Estimates are jittered to show confidence intervals (CIs). Time periods with too few visits for accurate estimation are excluded.
Figure 2.
Figure 2.
Trends in insulin used in treated diabetes visits by age, 2006–2015. Estimates are jittered to show confidence intervals (CIs). Time periods with too few visits for accurate estimation are excluded. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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