Prescribing trends of anti-diabetes medications near end-of-life among adults with type 2 diabetes: a cohort study
Objective
To assess prescribing trends of anti-diabetes medications in the last year of life among older adults with type 2 diabetes (T2D) and explore whether frailty is associated with differential prescribing.
Research design and methods
In this observational cohort study of Medicare beneficiaries aged ≥67 years (2015-2019) with T2D, we assessed temporal trends in prescribing an anti-diabetes medication, stratified by frailty. The main outcome included anti-diabetes medication fills within 1 year of death.
Results
Among 975,407 community-dwelling Medicare beneficiaries with T2D, the use of anti-diabetes medications within 1 year of death slightly increased from 71.4% during the first 6-month period in 2015 to 72.9% (standardized mean difference [SMD], -0.03) during the second 6-month period in 2019. The most pronounced increase in use was observed for metformin (40.7% to 46.5%; SMD, -0.12), whereas the largest decrease was observed for sulfonylureas (37.0% to 31.8%; SMD, 0.11). Overall anti-diabetes medication use decreased from 66.1% in the 9 to 12 months before death to 60.8% in the last 4 months of life (p<0.01; SMD, 0.11), driven by reduced non-insulin medication use. The use of both short-acting and long-acting insulin increased near death, with frailer individuals more likely to receive insulin. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, though less common, became more frequent in more recent years.
Conclusions
The use of anti-diabetes medications declined in the last year of life, mainly due to reduced non-insulin use. Insulin use increased near death, particularly among frailer individuals, highlighting the need for careful “end-of-life” management.
