Many Older Adults Receive Inpatient Diabetes Treatment Intensification

A study in JAMA Network Open found 10 percent of older adults hospitalized for common medical conditions are discharged with intensified diabetes medications, even though almost half are unlikely to benefit, reports Medical Xpress . The researchers analyzed 16,178 people 65 or older, mostly men, with diabetes not previously requiring insulin who were hospitalized in a Veterans Health Administration hospital for common medical conditions from 2012 to 2013. One out of 10 subjects were released with intensified diabetes medications, including 5 percent with new insulins and 3 percent with intensified sulfonylureas. However, 49 percent of those receiving intensification were unlikely to benefit on account of limited life expectancy or already being at their goal hemoglobin A1c (HbA1c). Twenty percent were expected to have potential benefit from intensification, and release with intensified diabetes medications was associated with both preadmission HbA1c level and inpatient blood glucose recordings. The predicted likelihood of receiving an intensification was 4 percent among subjects with a preadmission HbA1c level of less than 7 percent without elevated inpatient blood glucose levels, and 21 percent for those 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 concluded.