Takeaway
- Patients age ≥66 years prescribed insulin at hospital discharge are at increased risk for death, emergency department (ED) visits, or readmission within 30 days.
Why this matters
- Insulin therapy in older adults is associated with high risk for hypoglycemia.
Study design
- Retrospective study of 104,525 individuals age ≥66 years discharged from the hospital during 2004-2013, of whom:
- 9.2% were newly prescribed insulin within 7 days of discharge,
- 24.1% were prior (prevalent) insulin users,
- 7.4% were new oral hypoglycemic agent (OHA) users, and
- 59.3% were prevalent OHA users (referent).
- Funding: Ontario Ministry of Health and Long-Term Care.
Key results
- Within 30 days of discharge, 4.1% died and 26.2% had ED visits or readmissions.
- After adjustment for covariates, death risk was highest in new insulin users (adjusted HR, 1.59; 95% CI, 1.46-1.74).
- Prevalent insulin users and new OHA users had adjusted HRs for 30-day mortality of 1.12 (1.04-1.21) and 1.26 (1.11-1.44), respectively.
- Risk of ED visits/readmissions also significantly higher for:
- new insulin (1.17; 1.12-1.22),
- prevalent insulin (1.15; 1.11-1.18), and
- new OHA (1.05; 1.00-1.10) users.
Limitations
- Insulin prescriptions may not have been filled/followed.
- No information on some potential confounders (glycemic control, illness severity, etc.) or postdischarge follow-up patterns.
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