Prescribing Trends of Antidiabetes Medications Near End-of-Life Among Adults With Type 2 Diabetes: A Cohort Study

Abstract

OBJECTIVE To assess prescribing trends of antidiabetes 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 antidiabetes medication, stratified by frailty. The main outcome included antidiabetes medication fills within 1 year of death. RESULTS Among 975,407 community-dwelling Medicare beneficiaries with T2D, the use of antidiabetes 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 antidiabetes 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. CONCLUSIONS The use of antidiabetes 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.