Many older adults receive inpatient diabetes treatment intensification

(HealthDay)—One in 10 older adults hospitalized for common medical conditions are discharged with intensified diabetes medications, despite the fact that nearly half are unlikely to benefit from the intensification, according to a study published online March 24 in JAMA Network Open.

Timothy S. Anderson, M.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues assessed how often hospitalized older adults are discharged with intensified diabetes medications and the likelihood of benefit associated with these intensifications. The analysis included 16,178 patients (aged ≥65 years; 98 percent men) with diabetes not previously requiring insulin who were hospitalized in a Veterans Health Administration hospital for common medical conditions (2012 to 2013).

The researchers found that 10 percent of patients were discharged with intensified diabetes medications, including 5 percent with new insulins and 3 percent with intensified sulfonylureas. However, nearly half of patients receiving intensification (49 percent) were unlikely to benefit due to limited life expectancy or already being at their goal hemoglobin A1c (HbA1c). One in five were expected to have potential benefit from intensification. Discharge with intensified diabetes medications was associated with both preadmission HbA1c level and inpatient blood glucose recordings. The predicted probability of receiving an intensification was 4 percent among patients with a preadmission HbA1c level <7 percent, without elevated inpatient blood glucose levels, and 21 percent for patients with severely elevated inpatient blood glucose levels.

"During hospitalization, consideration of long-term diabetes control is needed in addition to inpatient blood glucose recordings to reduce potentially nonbeneficial medication changes when older adults are discharged home," the authors write.

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