700-P: Treatment of New-Onset Type 2 Diabetes after Age 65: A Longitudinal Cohort Study

As the U.S. population ages, more older adults will be newly diagnosed with type 2 diabetes (T2D). These individuals have a greater prevalence of comorbidities placing them at increased risk for T2D-related adverse drug events. We identified adults ≥ 65 within an integrated care system with newly diagnosed T2D, defined by a first elevated A1c (≥6.5%) with no evidence of T2D prior 18 months. We examined treatment initiation (metformin, sulfonylurea [SFU], insulin) during the 5 years following diagnosis among patients with 3 treatment-sensitive comorbid conditions (chronic kidney disease [CKD], dementia, frailty) at time of diagnosis. We compared A1c levels between treatment initiators vs. non-initiators and identified independent predictors of treatment initiation using multivariate logistic models. The 4,011 older adults with new T2D had mean age 72.2 ± 6.4 years, 53% were women, 50% were non-Hispanic white. Among those with advanced CKD (≥ stage 3b, 4% of cohort), nearly one-quarter (23%) were initiated on metformin (mean A1C 8.3 ± 2.7 vs. untreated 7.3 ± 1.4 p<0.01). Among people with dementia (1.8%), 27.8% were initiated on SFU (8.7 ± 1.2 vs. not treated 7.2± 1.2, p <0.01) and 8.3% on insulin (8.7 ± 2.8 vs. 7.5±1.5, p <0.34). Among frail elders (self-reported physically inactive [43%] or requiring a walker [5%]), 29.6% were started on SFU (8.6 ± 2.2 vs. not treated 7.2 ±1.4, p <0.01) and 7.5% on insulin (9.5 ± 2.8 vs. untreated 7.5 ± 1.6, p<0.01). Overall, 63% of the cohort was initiated on treatment, including 6.7% on insulin. Independent predictors of insulin initiation included age 65-74 (vs. 75+, aOR 1.42 [95% CI:1.03-1.95], p=0.03), higher A1c (aOR 4.86[3.60-6.56] per 1% increase), and presence of cardiovascular disease (1.52 [1.15-2.02], p<0.01). Among older adults with newly diagnosed T2D, treatment is frequently initiated among individuals with potentially risky co-morbid conditions. Our results suggest the need for more robust evidence-based guidelines tailored for older adults with newly diagnosed T2D.