When managing medications for frail elders, clinicians should take a hard look at insulin, say the researchers behind a new study.

Persistent insulin use among older adults in poor health is tied to an increased risk for hypoglycemia and limited future health benefits. In fact, leading medical organizations recommend reducing diabetes treatment intensity for elders who have multiple, life-limiting health conditions. But investigators have found that the opposite practice is occurring. 

“[I]n current practice we found that these sicker patients were less likely to stop taking insulin” when compared to their peers with better health, said senior author Richard W. Grant, M.D., MPH, Kaiser Permanente Division of Research, Oakland, California.

Grant and his team followed over 21,000 Kaiser Permanente members in Northern California aged 75 to 79 years with type 2 diabetes. Nearly one-fifth of the patients used insulin at the beginning of the study, and among that group, only about one-third discontinued its use over the next 4 years.

Insulin use was highest among older adults in poor health with a serious end-stage disease (at 29%), and those with intermediate health status who had at least two other health conditions (28% used insulin). In contrast, only 11% of those in good health used insulin. And the findings were similar even when the researchers took blood sugar control into account.

“These results suggest a need to better align current practice with guidelines that support reducing treatment intensity as health status declines,” Grant wrote.

“Revisiting the need for potentially harmful medications such as insulin when the risks outweigh the benefits can help to reduce adverse events like hypoglycemia and improve the quality of care in older patients,” he concluded.

The study was published this week in JAMA Internal Medicine.