(119) Glucose lowering medication utilization before and after entry into long-term care among older people with diabetes

Background: Older people with diabetes often experience multimorbidity and polypharmacy and are at risk of diabetes-related complications due to under- or over-treatment. Admission into long-term care (LTC) presents a key opportunity to review an individual’s care goals and diabetes treatment regimens. However, little is known about changes in glucose lowering medication (GLM) use during this period.

Objectives: To examine changes in GLM use in the 12-months before and after entry to LTC among older people with diabetes.

Methods: A national retrospective cohort study was conducted using linked health and aged care data from the National Historical Cohort of the Registry of Senior Australians (ROSA). LTC residents with diabetes aged 65 years and above who first entered LTC between January 2015 and December 2018 were included. GLM use was ascertained from pharmaceutical claims data. Prevalence of GLM use and number of defined daily doses (DDDs) dispensed per 1000 resident-days were determined in the 12-months before and 12-months after LTC entry on a quarterly (91-day) basis. The number of GLM classes, most commonly used regimen and changes in the regimen in the 3 months before and 9-12 months after entry was analyzed. Point estimates and 95% confidence intervals were estimated using Generalised Estimated Equation Poisson regression models (or negative binomial regression where overdispersion was present).

Results: Among the 50,993 residents included (56% female, median age 84 (interquartile range 78-88)), prevalence of GLM use was 58.4% (95%CI 58.0-58.8) in the 9-12 months prior to LTC entry and 56.3% (95%CI 55.9-56.8) in the 9-12 months post-entry. GLM use in the 3-months before LTC entry was 56.8% (95%CI 56.4-57.2) compared with 61.7% (95%CI 61.3-62.1) in the 3-months post-entry. Insulin use increased from 13.3% (95%CI 13.0-13.6) in the 3 months prior to LTC entry to 20.5% (95%CI 20.1-20.8) in the 3-months post-entry while the use of other GLM classes remained steady. Similar patterns in DDDs/1000 resident-days were also observed. Metformin, insulin, and metformin + sulfonylurea were the most commonly used regimens. Among 22,792 individuals dispensed a GLM in the 3 months prior to LTC entry (of whom 53.8% received monotherapy), 50.2% continued their therapy, 15% withdraw one or more GLM from their current regimen, 13.8% discontinued treatment, 15% added another GLM, and 6% switched in the 9-12 months post-LTC entry.

Conclusions: Use of insulin peaked in the first 3-months following admission into LTC, with little change in other GLM use in the year before and after LTC entry. Study findings suggest residents with diabetes may benefit from careful monitoring for diabetes complications such as hypoglycemia, particularly in the 3 months post-LTC entry.