Sulfonylureas (SFU) and basal insulin (BI) are to be used with caution in older adults due to safety risk (eg hypoglycemia). Using 2013-2017 data from a national insurer, we studied 84,720 Medicare Advantage adults ≥ 65 years (yrs) who started one of six antidiabetic medication (ADM) classes after metformin monotherapy. Outcomes were new start of SFU (vs. GLP-1 receptor agonists [GLP-1], SGLT2 inhibitors [SGLT2], thiazolidinediones [TZD], DPP-4 inhibitors [DPP-4]); or BI (vs. GLP-1, SGLT2, TZD, DPP-4). Multivariable logistic regression models examined associations between prescriber and patient characteristics (demographics, cognitive impairment [none, mild and severe], and diabetes related complications [diabetes complications severity index, DSCI score]). Most older adults received SFU followed by DPP-4, while few received GLP-1 and SGLT2 (SFU N=45,734 [54%], DPP-4 N=15,790 [19%], BI N=12,165 [14%], GLP-1 N=3,298 [4%], SGLT2 N=3,365 [4%], and TZD N=4,368 [5%]). Older subcategories of adults were increasingly more likely to receive SFU than those 65-67 yrs (70-74 yrs, OR1.08, 1.04-1.12; 75-79 yrs OR1.2, 1.13-1.25; ≥80 yrs OR1.35, 1.27-1.42). No differences in SFU use were seen in those with cognitive impairment and minority groups. For those receiving BI, females (vs. male OR 1.10, 1.05-1.15) and blacks (vs. whites OR1.26, 1.17-1.15) were more likely to receive BI. Those with severe cognitive impairment (vs. none OR1.98, 1.75-2.24) and high DSCI score (3+) (vs. 0 OR1.40, 1.31-1.50) were more likely to receive BI. Older subcategories of adults were less likely to receive insulin than 65-67 yrs of age (68-70 yrs, OR0.83, 0.77-0.89; 70-74 yrs, OR0.85, 0.80-0.90; 75-79 yrs OR0.93, 0.87-0.99). Older subcategories of adults were increasingly more likely to receive SFU; younger, cognitively impaired and those with diabetes complications were more likely to receive basal BI. Further research is needed to elucidate factors underlying differences in SFU and BI prescribing patterns.


K.E. DeCarlo: None. M. O’Brien: Research Support; Self; UnitedHealth Group. D.T. Liss: None. R. Kang: Research Support; Self; UnitedHealth Group. A.J. Cooper: None. M. Cherupally: None. E.D. Parker: None. C. Aikman: None. R.T. Ackermann: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, UnitedHealth Group. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group.


UnitedHealth Group (SP0036847)

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