Aging, comorbidity, and reduced rates of drug treatment for diabetes mellitus

Advanced age and its related comorbidity may affect both the patterns and g oals of diabetes treatment. We examined the relationships of demographic va riables and comorbidity with drug treatment for diabetes in the elderly. We studied both the 81,700 residents of New Jersey, aged 65-99 years, who wer e hospitalized between July 1, 1989 and June 30, 1991 and had prescription drug coverage either through Medicaid or the Pharmacy Assistance for the Ag ed and Disabled program, and a sample of 80,000 nonhospitalized elderly ben eficiaries in these programs. Plates of utilization of insulin or oral hypo glycemic drugs in the 120 days before admission were substantially lower in those aged greater than or equal to 85 or in nursing homes. Among patients with previously treated and diagnosed diabetes, the likelihood of treatmen t after discharge declined with older age (odds ratio [OR] for treatment in those aged greater than or equal to 85 relative to 65-74 years: 0.57; 95% confidence interval [CI]: 0.45-0.72), nursing hume residence (OR: 0.30; CI: 0.22-0.41), and higher levels of comorbidity (OR for modified Charlson ind ex greater than or equal to 5 relative to 0: 0.43; CI: 0.27-0.67). In patie nts who had a discharge diagnosis of diabetes but no Frier treatment, those in nursing homes and those with greater comorbidity also had lower rates o f diabetes treatment after discharge. Although the prevalence of diabetes i ncreases with age and the risks of many consequences of diabetes remain hig h, the rate of drug treatment for diabetes declines with older age and grea ter comorbidity, perhaps because of concern about side effects or reduced t reatment benefits due to competing risks of death. Absence of data from ran domized clinical trials of diabetes treatment in the elderly appears to hav e resulted in considerable physician ambivalence on the benefits and risks of glycemic control in older diabetics. J CLIN EPIDEMIOL 52;8:781-790, 1999 . (C) 1999 Elsevier Science Inc.