Initiating second-line antidiabetic medication among older adults with type 2 diabetes on Metformin

Kristen DeCarlo, Amisha Wallia, Raymond H. Kang, Andrew Cooper, Manisha Cherupally, Sterling A. Harris, Cassandra Aikman, David T. Liss, Ronald T. Ackermann, Matthew J. O’Brien*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Antidiabetic medications (ADM), especially sulfonylureas (SFU) and basal insulin (BI), are associated with increased risk of hypoglycemia, which is especially concerning among older adults in poor health. The objective of this study was to investigate prescribing patterns of ADM in older adults according to their health status. Methods: This case control study analyzed administrative claims between 2013 and 2017 from a large national payer. The study population was derived from a nationwide database of 84,720 U.S. adults aged ≥65, who were enrolled in Medicare Advantage health insurance plans. Participants had type 2 diabetes on metformin monotherapy, and started a second-line ADM during the study period. The exposure was a binary variable for health status, with poor health defined by end-stage medical conditions, dementia, or residence in a long-term nursing facility. The outcome was a variable identifying which second-line ADM class was started, categorized as SFU, BI, or other (i.e. all other ADM classes combined). Results: Over half of participants (54%) received SFU as initial second-line ADM, 14% received BI, and 32% received another ADM. In multivariable models, the odds of filling SFU or BI was higher for participants in poor health than those in good or intermediate health [OR 1.13 (95% CI 1.05-1.21) and OR 2.34 (95% CI 2.14-2.55), respectively]. SFU and BI were also more commonly filled by older adults with poor glycemic control. Conclusions: Despite clinical consensus to use caution prescribing SFU and BI among older adults in poor health, these medications remain frequently used in this particularly vulnerable population.

Original languageEnglish (US)
Article number97
JournalBMC Geriatrics
Issue number1
StatePublished - Dec 2022


  • Antidiabetic medications
  • Insulin
  • Older adults
  • Sulfonylureas
  • Type 2 diabetes

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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