917-P: Race/Ethnic Disparities in Insulin and Sulfonylurea Use in Older Patients with Type 2 Diabetes

Background: Risk of severe hypoglycemia increases markedly with age in type 2 diabetes (T2D) . For many older patients, discussion of safe de-prescribing strategies is indicated to reduce iatrogenic overtreatment. We examined differences in insulin and sulfonylurea (SU) prescription prevalence among older adults (age ≥ 75 years) by race/ethnicity. Because race/ethnic disparities among Black patients have been attributed to doctor-patient communication barriers, we tested the hypothesis that older Black patients were more likely to be prescribed medicines that can induce severe hypoglycemia.

Methods: We studied 18,149 adults (≥75 years) with T2D and a last measured HbA1c ≤ 8.0% between 2019-2021 in Kaiser Permanente Northern California. Electronic health records were used to identify prescription of insulin, SUs, or both. Medication treatment prevalence was stratified by race/ethnicity (Non-Latino White [NLW], Black, Latino, Asian, Other) and compared using chi-square tests.

Results: Mean age was 80.5 (±4.8) years; 54% were women; mean HbA1c was 6.9% (±0.7%) , with 42% prescribed insulin, 72% prescribed SUs and 13% prescribed both. Elderly Black and NLW patients had a higher insulin prevalence (both at 45%, p<0.001) , while Asians had the lowest (31%, p=<0.001) . Conversely, Blacks had the lowest SU prevalence (66%, p<0.001) , and Asians had the highest (79%, p<0.001) . A similar pattern was observed in patients with the tightest HbA1c control (< 7.0%; n=8,794) : Black patients had the highest insulin (39%, p<0.001) and lowest SU prevalence (69% p<0.001) , while Asians had the lowest insulin (26%, p<0.001) and highest SU prevalence (81%, p<0.001) .

Conclusion We found significant variation in use of high-risk medicines by race/ethnicity. Older Black patients had higher insulin use while older Asian patients had the highest SU use. Efforts to promote safe de-prescribing practices in older adults may need to be tailored to the unique physiologic and cultural needs of different patient groups.