Use and discontinuation of insulin treatment among adults aged 75 to 79 years with type 2 diabetes

JAMA Sep 30, 2019

Weine JZ, Gopalan A, Mishra P, et al. - In this cohort study of 21,531 adults with T2D followed for up to 4 years starting at age 75 years, researchers investigated whether insulin treatment was used less often and discontinued more frequently among older individuals with poor health in comparison with those in good health. Approximately one-fifth of 75-year-olds (n = 4,076) used insulin. Relative to those with good health, prevalence and adjusted risk ratios of insulin use at age 75 years were higher in people with poor health and intermediate health. Within 4 years of cohort entry (and at least 6 months prior to death), one-third (1,335 of 4,076) of insulin users at age 75 years stopped insulin. In contrast with good health (reference), the probability of sustained insulin use was greater among individuals in poor health and intermediate health. These similar prevalence and discontinuation designs were observed in the subset with tight glycemic control. Thus, in conclusion, in the elderly with T2D, insulin use was most prevailing among those in poor health, whereas in healthier patients, consequent insulin discontinuation subsequent to the age of 75 years was most apparent. In order to better adjust with guidelines that suggest decreasing treatment intensity as health status decreases, modifications in prevailing practice are required.
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