Antidiabetic treatment trends in a cohort of elderly people with diabetes - The Cardiovascular Health Study, 1989-1997

OBJECTIVE - This study characterizes the pharmaceutical treatment of type 2 diabetes from 1989-1990 to 1996-1997 in an elderly cohort. RESEARCH DESIGN AND METHODS - A total of 5,888 adults aged greater than or equal to 65 years were recruited and attended a baseline clinic visit in 19 89-1990 (n = 5,201, original cohort) or 1992-1993 (n = 687, African-America n [new] cohort) as participants of the Cardiovascular Health Study Fasting serum glucose (FSG) was measured at baseline. Medication use was ascertaine d by drug inventory at all annual clinic visits. Diabetes was defined at ba seline as insulin or oral hypoglycemic agent (OHA) use eras having an FSG g reater than or equal to 7.0 mmol/l (126 mg/dl), the current consensus defin ition of diabetes. RESULTS - A total of 387 (7%) original (FSG = 9.8 mmol/l [177 mg/dl]) and 1 15 (17%) new (FSG = 10.6 mmol/l [191 mg/dl]) cohort members had pharmacolog ically treated diabetes at baseline. Among those in the original and in the new cohorts who survived follow-up, respectively, OHA use decreased from 8 0 to 48% (P < 0.001) and from 67 to 50% (P < 0.003) and insulin use increas ed from 20 to 33% (P = 0.001) and from 33 to 37% (P = 0.603). There were 39 6 (8%) original (FSG = 8.8 mmol/l [159 mg/dl]) and 45 (7%) new (FSG = 10.0 mmol/l [181 mg/dl]) cohort members with diabetes untreated at baseline. Amo ng them, respectively, OHA use reached 38 and 30% and insulin use reached 6 and 16% in 1996-1997. CONCLUSIONS - Diabetes was common in this elderly cohort, and >80% of treat ed patients with diabetes at baseline were not achieving fasting glucose go als of less than or equal to 6.7 mmol/l (120 mg/dl). Many untreated at base line remained untreated after 7 years of follow-up.