Joshua D. Niznik PharmD, Ph.D.

Diabetes appears to be overtreated in nearly 44% of recently admitted nursing home residents, including those with limited life expectancy and/or advanced dementia, reveals a Veterans Administration study. 

The retrospective study analyzed health data collected from residents within 90 days of admission from 2009 to 2015. Fully 79% of overtreated residents were found to have a moderately high risk of dying within six months. Investigators also found that:

  • About 29% of overtreated residents had advanced dementia
  • Nearly 14% were classified as having end-of-life status
  • Many were physically dependent and had heart disease and/or potential diabetes-related complications 
  • About 9% had a serious low blood sugar episode in the year prior, emphasizing a need for deintensification

Nearly half of the studied residents received two or more diabetes medications, and those with higher HbA1c values of between 6.5% to 7.5% received more diabetes medications than those with lower HbA1c.

Deintensification occurred in less than half of overtreated residents and was more strongly tied to low HbA1c values and use of medications that can cause hypoglycemia than to other resident characteristics, the researchers reported.

The only resident factor associated with increased likelihood of deintensification was documented end‐of‐life status, reported Joshua D. Niznik, PharmD, Ph.D., from the University of North Carolina and colleagues. Meanwhile, admission from home or assisted living, obesity, and peripheral vascular disease were associated with decreased odds of deintensification.

Deintensification was defined as decreasing dosage or completely discontinuing a non‐insulin medication, and/or stopping an insulin type with no addition of new medication or any dose increase of a non‐insulin agent.

The study was published in the Journal of the American Geriatrics Society.