Kutz Alexander, Kim Dae Hyun, Liu Jun, Munshi Medha N, Patorno Elisabetta
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.
Diabetes Care. 2025 Mar 1;48(3):455-463. doi: 10.2337/dc24-1795.
To assess prescribing trends of glucose-lowering medications in the last year of life among older adults with type 2 diabetes (T2D) and explore whether frailty is associated with differential prescribing.
In this observational cohort study of Medicare beneficiaries aged ≥67 years (2015-2019) with T2D, we assessed temporal trends in prescribing a glucose-lowering medication, stratified by frailty. The main outcome included glucose-lowering medication fills within 1 year of death.
Among 975,407 community-dwelling Medicare beneficiaries with T2D, the use of glucose-lowering 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 glucose-lowering medication use decreased from 66.1% in the 9 to 12 months before death to 60.8% in the last 4 months of life (SMD 0.11; P < 0.01), driven by reduced noninsulin medication use. The use of short-acting and long-acting insulin both increased near death, with frailer individuals more likely to receive insulin. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists, although less common, became more frequent in more recent years.
The use of glucose-lowering medications declined in the last year of life, mainly due to reduced noninsulin use. Insulin use increased near death, particularly among frailer individuals, highlighting the need for careful end-of-life management.
评估2型糖尿病（T2D）老年患者生命最后一年降糖药物的处方趋势，并探讨虚弱是否与不同的处方情况相关。
在这项针对年龄≥67岁（2015 - 2019年）患有T2D的医疗保险受益人的观察性队列研究中，我们评估了按虚弱分层的降糖药物处方的时间趋势。主要结局包括死亡前1年内的降糖药物配药情况。
在975,407名社区居住的患有T2D的医疗保险受益人中，死亡前1年内降糖药物的使用从2015年第一个6个月期间的71.4%略有增加至2019年第二个6个月期间的72.9%（标准化平均差[SMD] -0.03）。二甲双胍的使用增加最为显著（从40.7%增至46.5%，SMD -0.12），而磺脲类药物的使用下降幅度最大（从37.0%降至31.8%，SMD 0.11）。总体降糖药物使用从死亡前9至12个月的66.1%降至生命最后4个月的60.8%（SMD 0.11；P < 0.01），这是由于非胰岛素药物使用减少所致。短效和长效胰岛素的使用在临近死亡时均增加，虚弱个体更有可能接受胰岛素治疗。钠 - 葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽1受体激动剂虽然使用较少，但近年来使用频率有所增加。
降糖药物的使用在生命最后一年有所下降，主要原因是非胰岛素药物使用减少。胰岛素使用在临近死亡时增加，尤其是在虚弱个体中，这凸显了进行谨慎的临终管理的必要性。
