Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults.

Background/Objectives The treatment of type 2 diabetes in older adults requires special considerations including avoidance of hypoglycemia, yet variation in diabetes treatment with aging is not well understood. In this study, we compared nationally representative diabetes treatment patterns and trends between older adults (>= 65 y) and younger adults (30-64 y). Design Repeated cross-sectional physician surveys from 2006 to 2015. Setting The National Ambulatory Medical Care Survey, an annual probability sample of visits to office-based US physicians. Participants Adults with type 2 diabetes using one or more diabetes medications. Measurements Proportions of visits in which patients treated with each diabetes medication class were compared between older and younger adults in 2-year intervals. Results From 2006 to 2015, the average number of yearly visits for older and younger adults was 25.4 million and 24.2 million, respectively. In 2014-2015, visits for older compared with younger adults involved less use of metformin (56.0% vs 70.0%; p < .001) and glucagon-like peptide 1 receptor agonists (2.9% vs 6.2%; p = .004), and more use of long-acting insulin (30.2% vs 22.4%; p = .017); other classes were used similarly. During the study period, long-acting insulin use increased markedly in older adults, particularly between 2010 and 2015 where it rose from 12.5% to 30.2% of visits (P-trend <.001). In younger adult visits, long-acting insulin use increased modestly (17.2% to 22.4%) and at a slower rate compared with older adult visits (p < .001). Conclusion The ambulatory treatment of type 2 diabetes differs between older and younger adults, with the treatment of older adults characterized by low use of newer diabetes medications and a greater and rapidly increasing use of long-acting insulin. These findings call for further research clarifying the comparative effectiveness and safety of newer diabetes medications and long-acting insulin to optimize diabetes care for older patients. J Am Geriatr Soc 67:1066-1073, 2019.