Sulfonylurea Deintensification Rates Low After Hospitalization for Hypoglycemia

[adace-ad id="3134"]

The ultimate goal of a recent study was to examine the removal of intensity of sulfonylurea and insulin therapy, following an emergency department visit associated with hypoglycemia (ED) or hospitalization among elderly people with diabetes.

Led by Anastasia-Stefania Alexopoulos, MBBS, Department of Medicine, Division of Endocrinology, Duke University, researchers observed that sulfonylureas and/or insulin clearance over the next 100 days occurred in less than 50% of patients after a hypoglycemic-associated ED visit. blood or hospitalization. .

Techniques

Investigators analyzed medical claims, as well as records of prescription drugs, to include a random sample of 20% of Medicare fee recipients nationwide.

[adace-ad id="3134"]

Medicare fees consist of health insurance claims for patients with Medicare Part A (inpatient services), Part B (outpatient care), and Part D (outpatient clinics for prescription drugs). Study recipients were 65 years of age and older, with ≥1 visit or hospital admission associated with hypoglycemia between January 2007 – December 2017.

Included patients had at least one prescription for a sulfonylurea or insulin or both a sulfonylurea and insulin within the 6 months prior to the indication date.

[adace-ad id="3134"]

Primary outcomes were defined as de-intensification of sulfonylurea and/or insulin therapy at 100 days after a hypoglycemic-associated ED visit or hospitalization.

Accordingly, the study defined non-intensification as either not filling a baseline sulfonylurea prescription and/or insulin within 100 days after the indicator event, and a prescription filled with a sulfonylurea within 100 days after the indicator event at a lower dose compared to the last prescription before the indicator event , or change from a long-acting sulfonylurea to glipizide within 100 days after the indication event.

the findings

In the study, a total of 76,728 distinct Medicare beneficiaries were identified with a mean age of 76.6 years. The data indicate that of a total of 106,293 hypoglycemic episodes requiring hospital attention, 69,084 (65.0%) occurred among women, 26,056 (24.5%) among black individuals, and 4,761 (4.5%) among Hispanic individuals, 69,704 (65.6) %) among white individuals.

It was found that a total of 32,074 episodes (30.2%) occurred among those who received a sulfonylurea only, while 60,350 (56.8%) occurred among patients receiving insulin only and 13,869 (13.0%) occurred among those receiving both sulfonylureas and insulin.

Furthermore, the unadjusted incidence of treatment intensity clearance rates was highest for individuals receiving sulfonylurea and insulin therapies at the time of the hypoglycemic episode (n = 6677, 48.1%), followed by sulfonylureas only (n = 14192, 44.2%) And insulin only (n = 14495, 24.0%).

Alexopoulos and colleagues observed an increase in treatment intensity clearance rates between 2007-2017 (sulfonylureas only: from 41.4% to 49.7%, s < .001 for direction; Insulin only from 21.3% to 25.9%. s < .001 for direction; Sulfonylureas and insulin, from 45.9% to 49.6%. s = .005 for direction).

In addition, lower socioeconomic status decreased odds of dehydration (sulfonylureas only: AOR, 0.74, 95% CI, 0.70–0.78; insulin only, AOR 0.71, 95% CI, 0.68–0.75; sulfonylureas and insulin: AOR). , 0.72, 95% CI, 0.66 – 0.78).

Other patient factors were associated with higher odds of treatment intensity clearance in those receiving sulfonylureas and insulin, including higher impairment (AOR, 1.50; 95% CI, 1.32 – 1.71), chronic kidney disease (AOR, 1.29; 95% CI, 1.19 – 1.40), date of fall (AOR, 1.20; 95% CI, 1.09 – 1.33), and depression (AOR, 1.11; 95% CI, 1.02 – 1.20).

Takeaway

The investigators noted the potential for underestimation of decondensation rates, due to the inability to capture changes in insulin doses from claims data.

“Although there is a pattern of increased clearance of sulfonylureas and/or insulin over a 10-year period, lower overall rates of clearance of sulfonylureas suggest that real-world practice may lag behind evidence that severe hypoglycemia is a significant health and safety concern. Among the elderly they wrote.

The study “De-intensive removal of sulfonylurea and insulin therapy after severe hypoglycemia among elderly diabetic patients” was published in JAMA Network is open.

[adace-ad id="3134"]

Leave a reply:

Your email address will not be published.

Site Footer

Sliding Sidebar