Prevalence and pattern of use of oral antihyperglycemic drugs and insulin in a population of diabetic patients in nursing homes: Results from the SHELTER Study

Objectives: Describe prevalence and pattern of use of antidiabetic drugs in elderly people with diabetes mellitus residing in nursing homes (DMRs), and to identify individual socio-demographic and clinical features associated with these drugs. Design(s): Cross-sectional analysis of the Services and Health for Elderly in Long TERm care (SHELTER) database. SHELTER is a 12-month prospective cohort study, conducted between 2009 and 2011, to assess Nursing home (NH) residents in 7 European countries and Israel. Method(s): The study included 4037 residents in 59 NH during the 3-month enrollment period. The multidimensional InterRAI instrument for Long-Term Care Facilities (InterRAI-LTCF) was used to assess health and functional status. Descriptive statistics and logistic regression models were used to perform the analyses. Result(s): About 61.3% of DMRs were treated with antidiabetic drugs (33% with oral antihyperglycemic drugs (OAD), 22% with insulin (Ins) and 6% with combined therapy (OAD + Ins)). Among the OAD, Biguanides were the most prescribes drugs (53%). Non treated residents were more likely to be female, older, with a higher BMI and with more severe cognitive decline. DMRs treated with Ins presented more severe functional decline. Ins+OAD was associated with lower prevalence of cognitive impairment, depression, urinary incontinence and pain. Conclusion(s): Over 60% of DMRs receive pharmacological treatment with antidiabetic drugs. Advanced age is the main barrier to treatment, while severity of cognitive and functional decline may influence the prescribing choice. Further studies are needed to confirm these findings and evaluate the effectiveness of antidiabetic treatment in frail elderly population.