National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities

Yohanes A Wondimkun; Gillian E Caughey; Maria C Inacio; Georgina A Hughes; Tracy Air; Robert N Jorissen; Michelle Hogan; Janet K Sluggett

doi:10.1016/j.diabres.2024.111701

National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities

Diabetes Res Clin Pract. 2024 May 7:212:111701. doi: 10.1016/j.diabres.2024.111701. Online ahead of print.

Authors

Yohanes A Wondimkun¹, Gillian E Caughey², Maria C Inacio², Georgina A Hughes³, Tracy Air⁴, Robert N Jorissen², Michelle Hogan⁵, Janet K Sluggett²

Affiliations

¹ University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Hawassa University, College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia. Electronic address: yohanes.wondimkun@mymail.unisa.edu.au.
² University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
³ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia.
⁴ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
⁵ Australian Government Aged Care Quality and Safety Commission, Adelaide, South Australia, Australia.

PMID: 38719026
DOI: 10.1016/j.diabres.2024.111701

Abstract

Aims: To examine national trends in glucose lowering medicine (GLM) use among older people with diabetes in long-term care facilities (LTCFs) during 2009-2019.

Methods: A repeated cross-sectional study of individuals ≥65 years with diabetes in Australian LTCFs (n = 140,322) was conducted. Annual age-sex standardised prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Multivariable Poisson or Negative binomial regression models were used to estimate adjusted rate ratios (aRRs) and 95 % confidence intervals (CIs).

Results: Prevalence of GLM use remained steady between 2009 (63.9%, 95 %CI 63.3-64.4) and 2019 (64.3%, 95 %CI 63.9-64.8) (aRR 1.00, 95 %CI 1.00-1.00). The percentage of residents receiving metformin increased from 36.0% (95 %CI 35.3-36.7) to 43.5% (95 %CI 42.9-44.1) (aRR 1.01, 95 %CI 1.01-1.01). Insulin use also increased from 21.5% (95 %CI 21.0-22.0) to 27.0% (95 %CI 26.5-27.5) (aRR 1.02, 95 %CI 1.02-1.02). Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95 %CI 0.9-1.1) to 21.1% (95 %CI 20.7-21.5) (aRR 1.24, 95 %CI 1.24-1.25), while sulfonylurea use decreased from 34.4% (95 %CI 33.8-35.1) to 19.3% (95 %CI 18.9-19.7) (aRR 0.93, 95 %CI 0.93-0.94). Similar trends were observed in DDDs/1000 resident days.

Conclusions: The increasing use of insulin and ongoing use of sulfonylureas suggests a need to implement evidence-based strategies to optimise diabetes care in LTCFs.

Keywords: Australia; Diabetes; Hypoglycaemic agents; Long-term care facilities; Nursing homes.