Description
- Abstract:
- Background: Despite data from younger populations suggesting that glipizide is the preferred sulfonylurea due to its lower risk of adverse effects, long-acting sulfonylureas (glimepiride and glyburide) are still prescribed often and at non-geriatric initial doses in the nursing home (NH) setting, which may increase the risk of severe hypoglycemia and subsequently worsen functioning. Since different drugs and doses within the sulfonylurea class are associated with different risks of adverse effects that impacts cognitive and physical functioning, they may also affect cognition and functioning differently among older adults. Therefore, in this study we estimated the drug- and dose-specific effects of sulfonylureas on cognition and physical functioning among older NH residents. Methods: We conducted a retrospective, new-user cohort study of NH residents in 2007-2010 using national data from the Minimum Data Set (MDS) and Medicare Parts A, B, and D claims (N=6,177). Follow-up began at the initial dispensing of a sulfonylurea and continued until each study outcome (evaluated separately), insurance disenrollment, death, 6-month follow-up, or study end, whichever occurred first. The five outcomes were cognitive decline, cognitive improvement, functional decline, functional improvement, and altered mental status hospitalization/emergency room visit. Cognitive decline and improvement were measured using the MDS Cognitive Performance Scale. Functional decline and improvement were measured using the MDS Activities of Daily Living Scale. Inverse-probability-of-treatment-weighted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to compare glimepiride versus glipizide and glyburide versus glipizide users. Using the same approach in a separate analysis, we evaluated geriatric versus non-geriatric initial dose. Results: Glyburide users were less likely to have a functional improvement than glipizide users (HR=0.83, 95%CI 0.67-1.03), though this finding was non-significant. Compared to individuals receiving geriatric doses, those who received non-geriatric initial sulfonylurea doses had fewer functional decline (HR=0.89, 95%CI 0.80-0.99) and cognitive decline (HR=0.89, 95%CI 0.78-1.00) events. No other marked differences were observed by drug or dose. Conclusions: We observed no difference in cognitive or physical functional events between individual sulfonylurea drug users. Non-geriatric initial sulfonylurea dose was associated with less cognitive and functional decline. Residual confounding remains a plausible explanation for the findings.
- Notes:
- Thesis (Sc. M.)--Brown University, 2018
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Citation
Sharmin, Sadia,
"Drug- and Dose-Specific Effects of Sulfonylureas on Cognition and Physical Functioning in Older Nursing Home Residents"
(2018).
Epidemiology Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/5p1e-2p73
