Impact of Age, Frailty, and Dementia on Prescribing for Type 2 Diabetes at Hospital Discharge 2012–2016

• Published in: The Journal of frailty & aging Vol. 10; no. 4; pp. 343 - 349
• Main Authors: Wood, Stephen J, Bell, J. S, Magliano, D. J, Fanning, L, Cesari, M, Keen, C. S, Ilomäki, J
• Format: Journal Article
• Language: English
• Published: Rome Springer Nature B.V 2021
• Subjects: Age; Codes; Cohort analysis; Comorbidity; Complications; Dementia; Diabetes; Frailty; Glucose; Heart attacks; Hospital discharged; Hospitalization; Hospitals; Hypoglycemia; Insulin; Ischemia; Kidney diseases; Older people; Patient admissions; Patients; Prescribing; Transient ischemic attack; Type 2 diabetes mellitus
• ISSN: 2260-1341; 2273-4309
• DOI: 10.14283/jfa.2021.6

BackgroundThe risks of intensive blood glucose lowering may outweigh the benefits in vulnerable older people.ObjectivesOur primary aim was to determine whether age, frailty, or dementia predict discharge treatment types for patients with type 2 diabetes (T2D) and related complications. Secondly, we aimed to determine the association between prior hypoglycemia and discharge treatment types.Design, Setting and ParticipantsWe conducted a cohort study involving 3,067 patients aged 65–99 years with T2D and related complications, discharged from Melbourne’s Eastern Health Hospital Network between 2012 and 2016.MeasurementsMultinomial logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) for the association between age, frailty, dementia and hypoglycemia, and being prescribed insulin-only, non-insulin glucose-lowering drugs (GLDs) or combined insulin and non-insulin GLDs compared to no GLD. International Classification of Diseases-10 codes were used to identify dementia status and prior hypoglycemia; frailty was quantified using the Hospital Frailty Risk Score.ResultsInsulin-only, non-insulin GLDs, combined insulin and non-insulin GLDs, and no GLDs were prescribed to 19%, 39%, 20%, and 23% of patients, respectively. Patients >80 years were less likely than patients aged 65–80 to be prescribed any of the GLD therapies, (eg. non-insulin GLDs [OR 0.67; 95%CI 0.55–0.82]), compared to no GLD. Similarly, high vs. low frailty scores were associated with not being prescribed any of the three GLD therapies, (eg. non-insulin GLDs [OR 0.63; 95%CI 0.45–0.87]). However, dementia was not associated with discharge prescribing of GLD therapies. Patients with a hypoglycemia-related admission were more likely than those not hospitalized with hypoglycemia to receive insulin-only (OR 4.28; 95%CI 2.89–6.31).ConclusionsClinicians consider age and frailty when tailoring diabetes treatment regimens for patients discharged from hospital with T2D and related complications. There is scope to optimize prescribing for patients with dementia and for those admitted with hypoglycemia.