SAT-627 - Sulfonylurea Use Transitions in A Longitudinal Geriatric Cohort

Background
De-intensification of hypoglycemia inducing agents in older adults is recommended by the American Diabetes Association. Sulfonylurea use has decreased since 2006 among older adults in the United States (US), a change attributed to the updated practice guidelines. However recent surveys identified reluctance among both patients and physicians to de-intensify hypoglycemia inducing medications. Alternatively, disease progression may necessitate intensification to insulin. In this study we sought to characterize longitudinal medication state transitions among older adults with diabetes on sulfonylurea medication.
Methods
The National Social Life, Health & Aging Project (NSHAP) is a longitudinal in-home survey following 3,005 older, community dwelling adults in the US born in 1920-1947, with in-person medication data collection. Survey round 1 (R1) was conducted in 2005-6, R2 in 2010-11, and R3 in 2015-16. Responses were survey weighted.
Those with self-reported diabetes on sulfonylurea medication (excluding those on insulin or meglitinides) in R1 were followed in R2 and R3 to identify 1) de-intensification of hypoglycemia inducing agents, 2) progression to insulin, 3) death or unable to interview. We used a transition probability matrix to characterize transitions between these states in each round. Data analysis performed using Stata version 19.5.
Results
Among 3,005 participants in R1, 642 had self-reported diabetes. Overall, the prevalence of sulfonylurea use decreased from 40.8% (n=259/635) to 33.8% (n=206/586) and 24.1% (n=111/458) in rounds 1, 2, and 3 respectively. New sulfonylurea starts decreased from 18.6% (n=79/400) in R2 to 13.1% (n=34/285) in R3.
For subsequent analysis, we included 240 participants on sulfonylurea medication without other hypoglycemia inducing medications in R1 in a transition probability matrix. The probability of remaining on sulfonylurea therapy was 38.0%. Intensification to insulin accounted for 12% of transitions, and de-intensification to non-hypoglycemic medications or no medications accounted for 13.7%. Censoring events accounted for 36.3% of transitions, of which 13.5% unable to interview and 22.8% death.

Discussion:
Similar to other population studies, we found declining rates of sulfonylurea use over time and decreasing rates of new prescriptions. There was high variability in sulfonylurea use states over the 10 year period. Intensification to insulin and de-escalation to non-hypoglycemic medications or no medications accounted for a similar percent of transitions, 12% and 13.7% respectively. However censoring events, inability to interview due to poor health or death, accounted for the largest proportion of transitions, around 36%. This study identifies the relative contributions of various dynamics occurring within a population over time that lead to observed changes in medication utilization.

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