Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes复制标题

75 ~ 79岁2型糖尿病患者使用和停止胰岛素治疗

Existing guidelines recommend individualizing glycemic targets based on health status but do not make specific recommendations about insulin use. We studied the prevalence of insulin use and discontinuation among a cohort of 75-yearolds with type 2 diabetes to test the hypothesis that older adults with poor health would be less likely to use insulin and bemore likely to discontinue insulin over time. We found that nearly 1 in 5 individuals were receiving insulin therapy at age 75 years. Insulin use was most prevalent among those in poor health, whereas subsequent insulin discontinuation after age 75 years was most likely in healthier patients, even after accounting for level of glycemic control. The results of this study suggest that neither prevalent insulin use nor subsequent insulin discontinuation among older patients is closely aligned with current recommendations to incorporate health status (in conjunction with life expectancy  and patient preferences) when making treatment decisions. These patterns remained evident even when accounting for level of glycemic control. For example, we would expect to find less insulin discontinuation among relatively healthy patients with poor glycemic control (HbA1c≥8.5%) relative to less healthy patients because these healthier patients are more likely to realize long-term clinical benefit with the tighter control that would be expected from continuing insulin therapy. However, Figure 3B demonstrates that discontinuation follows the opposite pattern: patients with poor health are least likely to discontinue insulin.

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