National Trends in Type 2 Diabetes Treatment—Comparing Older and Younger Adults

With expanding therapeutic options for type 2 diabetes, the treatment of older adults requires special care to balance safety and complexity with glucose control. We compared national trends in type 2 diabetes treatment among older (≥65 years) and younger adults (30-64 years) using the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), an annual probability sample of visits to U.S. outpatient providers. We included all visits of patients with type 2 diabetes using ≥1 diabetes medication. Analyses were weighted to yield nationally-representative estimates. In the most recently available data, 2014-2015, there were 23.3 million and 20.1 million annual treated diabetes visits for older and younger adults, respectively. The most frequently used medications in older and younger adult visits were metformin (50.4% vs. 62.3% respectively, p<0.001), sulfonylureas (31.1% vs. 26.7%, p=0.301), and long-acting insulins (30.2% vs. 22.4%, p=0.017). GLP-1 receptor agonists were used in fewer older than younger adult visits (2.9% vs. 6.2%, p=0.004); DPP-4 inhibitor use was similar (12.9% vs. 11.1%). In the past decade, mean diabetes medication counts increased in both older and younger adult visits (1.47 to 1.54, p-trend=0.046; and 1.53 to 1.67, p-trend 0.052, respectively). Between 2006 and 2015, the proportion of visits with metformin, DPP-4 inhibitors, and insulin increased for both older and younger adults; sulfonylurea and thiazolidinedione use decreased (p<0.05 for all trends). Long-acting insulin use increased markedly in older adults, particularly between 2010-2015 where it rose from 12.5% to 30.2% of older adult visits. In younger adult visits, the increase was modest, from 17.2% to 22.4%, a slower rate of increase than in older adults (p-interaction <0.001).

In conclusion, the outpatient treatment of type 2 diabetes differs between older and younger adults driven in part by a marked increase in the use of long-acting insulin among older adults, which may have implications for risk of hypoglycemia.