Description
- Abstract:
- Little evidence exists to guide selection of medicines to treat geriatric patients with type 2 diabetes mellitus (T2D). The need for evidence pertaining to frail elderly persons is critical, especially among nursing home (NH) residents. The overall objectives of this dissertation were 1) to understand how treatments for T2D are selected for older adults in the NH setting, 2) to quantify the effects of treatments for T2D on cardiovascular (CV)-related and serious hypoglycemic events, and 3) to quantify the effects of treatments for T2D on cognitive and physical functioning outcomes in older NH residents. We analyzed a secondary database that included all U.S. Medicare fee-for-service beneficiaries who are NH residents for ≥90 days between 2007 and 2010. The data includes the Minimum Data Set (MDS) for NH resident assessment linked to Medicare Parts A, B, and D claims data. These data include validated assessments of cognitive and physical functioning (MDS) and serious hypoglycemia, stroke, heart failure, and CV events (myocardial infarction, unstable angina)(claims). In Chapter 1, advanced age, and the presence of heart failure or renal disease were predictive of initiating sulfonylureas (SUs) over metformin among older NH residents with T2D. The Chapter 1 findings suggest that providers in the NH consider FDA safety warnings when prescribing medications. In Chapter 2, compared with SUs, dipeptidyl peptidase-4 inhibitor (DPP4I) medications may have resulted in a lower risk of hypoglycemic and stroke events, but appeared to have little impact on hyperglycemic, major adverse CV, or heart failure events in older NH residents. In Chapter 3, compared with SUs, DPP4Is may have resulted in a lower risk of cognitive decline and altered mental status events, but appeared to have little impact on physical functioning in older NH residents. Although biases from differences in loss to follow-up remain a plausible alternative explanation for the findings, DPP4Is may be the preferred second-line T2D medication class for optimizing outcomes among older NH residents. Taken together, the findings from the three chapters of this dissertation can help improve the prescribing of T2D treatments and subsequent health outcomes for frail older adults who reside in NHs.
- Notes:
- Thesis (Ph. D.)--Brown University, 2016
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Citation
Zullo, Andrew R.,
"Use, Safety, and Effectiveness of Diabetes Medications in Older Nursing Home Residents"
(2016).
Health Services, Policy & Practice Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.7301/Z05D8Q9H
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Health Services, Policy & Practice Theses and Dissertations
Theses and Dissertations for the Health Services, Policy & Practice department....