(127) National trends in utilization of glucose lowering medications by older people with diabetes in long-term care facilities, 2009 to 2019

Tuesday, August 27, 2024

8:00 AM – 6:00 PM CEST

Location: Convention Hall II

Presenting Author(s)

Yohanes A. Wondimkun, Msc, Bpharm

PhD student
University of South Australia
Adeliade, Australia

Co-Author(s)

GC

Gillian E. Caughey, PhD

Professor
Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Adelaide, Australia
MI

Maria C. Inacio, MS, PhD

Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Adelaide, Australia
GH

Georgina A. Hughes, BPharm (Hons)

PhD Candidate
UniSA Clinical & Health Sciences, University of South Australia, Australia
Tracy Air, M.Biostat

Statistician
Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Adelaide, Australia
RJ

Robert N. Jorissen, PhD, MBiostat

Senior Post-doctoral Researcher
Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Adelaide, Australia
Michelle E. Hogan, MNSc

Director Clinical Unit, Aged Care Quality and Safety Commission
University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
West Croydon, Australia
Janet K. Sluggett, PhD, BPharm(Hons), GDip ClinEpid, FANZCAP, FSHP (she/her/hers)

Associate Professor in Pharmacy and Pharmacoepidemiology
University of South Australia
Adelaide, Australia

Background: Diabetes affects up to one third of individuals in long-term care facilities (LTCFs), and its management is often affected by multimorbidity, cognitive impairment, and frailty. Little is known about glucose lowering medication (GLM) use by older people with diabetes in LTCFs, including the newer classes of GLMs.

Objectives: To examine national trends in GLM use among older people with diabetes who resided in Australian LTCFs between 2009 and 2019.

Methods: A repeated cross-sectional study of individuals aged 65 years and above with diabetes living in LTCFs between 2009-2019 was conducted using linked health and aged care data from the Registry of Senior Australians. Annual crude and age-sex standardized prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Trends were examined using Poisson and Negative binomial regression models.

Results: There were 140,322 individuals living with diabetes in 3,273 LTCFs included in this study, with 126,085,835 resident-days analysed. The overall prevalence of GLM use did not change between 2009 (63.9%, 95%CI 63.3-64.4) and 2019 (64.3%, 95%CI 63.9-64.8) (adjusted rate ratio (aRR) 1.00, 95%CI 1.00-1.00). Small increases were observed in metformin (from 36.0%, 95%CI 35.3-36.7 to 43.5%, 95%CI 42.9-44.1; aRR 1.01, 95%CI 1.01-1.01) and insulin use (from 21.5%, 95%CI 21.0-22.0 to 27.0%, 95%CI 26.5-27.5; aRR 1.02, 95%CI 1.02-1.02), over the study period. Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95%CI 0.9-1.1) to 21.1% (95%CI 20.7-21.5) (aRR 1.24, 95%CI 1.24-1.25) while sulfonylurea use decreased from 34.4% (95%CI 33.8-35.1) to 19.3% (95%CI 18.9-19.7; aRR 0.93, 95%CI 0.93-0.94) between 2009 and 2019. Similar trends were observed in DDDs/1000 resident days.

Conclusions: Between 2009 and 2019 the use of sulfonylureas decreased, while use of metformin, insulin and DPP-4 inhibitors increased. The high prevalence of sulfonylurea and insulin use observed suggests a need to implement evidence-based strategies to optimize diabetes care and minimize the risk of hypoglycemia in LTCFs.