Older patients discharged on insulin may be at risk

  • Lysy Z & al.
  • J Gen Intern Med
  • 12 Feb 2019

  • curated by Miriam Tucker
  • Clinical Essentials
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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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