Evidence mapPaperPMID 39746144Full record

Observational studyDiabetes care2025

Prescribing Trends of Glucose-Lowering Medications Near End of Life Among Adults With Type 2 Diabetes: A Cohort Study.

Alexander Kutz, Dae Hyun Kim, Jun Liu, Medha N Munshi, Elisabetta Patorno

Abstract readObservational Study
In one paragraph

Observational study in Diabetes care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Alexander KutzDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.ORCID 0000-0002-7549-5648
Dae Hyun KimDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Jun LiuDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Medha N MunshiJoslin Diabetes Center, Harvard Medical School, Boston, MA.ORCID 0000-0001-6917-4197
Elisabetta PatornoDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.ORCID 0000-0002-8809-9898

Funding

Novel approaches to improve comparative effectiveness research of medical and surgical weight reduction strategies in clinical practiceR01DK138036 · BRIGHAM AND WOMEN'S HOSPITAL · 2025 to 2025
$773k
Mid-Career Mentoring Award For Patient-Oriented Research in Frailty and Health OutcomesK24AG073527 · HEBREW REHABILITATION CENTER FOR AGED · 2025 to 2025
$172k
FDA HHS 5U01FD007213FDA HHS U01 FD007213NIA NIH HHS K24 AG073527NIDDK NIH HHS R01 DK138036NIDDK NIH HHS R01DK138036Novo NordiskPatient Centered Outcomes Research Institute DB-2020C2-20326Swiss National Science Foundation P400PM_194479 / 1the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
6 · The paper itself

Abstract

objectiveTo assess prescribing trends of glucose-lowering medications in the last year of life among older adults with type 2 diabetes (T2D) and explore whether frailty is associated with differential prescribing. RESEARCH DESIGN AND

methodsIn this observational cohort study of Medicare beneficiaries aged ≥67 years (2015-2019) with T2D, we assessed temporal trends in prescribing a glucose-lowering medication, stratified by frailty. The main outcome included glucose-lowering medication fills within 1 year of death.

resultsAmong 975,407 community-dwelling Medicare beneficiaries with T2D, the use of glucose-lowering medications within 1 year of death slightly increased from 71.4% during the first 6-month period in 2015 to 72.9% (standardized mean difference [SMD] -0.03) during the second 6-month period in 2019. The most pronounced increase in use was observed for metformin (40.7% to 46.5%, SMD -0.12), whereas the largest decrease was observed for sulfonylureas (37.0% to 31.8%, SMD 0.11). Overall glucose-lowering medication use decreased from 66.1% in the 9 to 12 months before death to 60.8% in the last 4 months of life (SMD 0.11; P < 0.01), driven by reduced noninsulin medication use. The use of short-acting and long-acting insulin both increased near death, with frailer individuals more likely to receive insulin. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists, although less common, became more frequent in more recent years.

conclusionsThe use of glucose-lowering medications declined in the last year of life, mainly due to reduced noninsulin use. Insulin use increased near death, particularly among frailer individuals, highlighting the need for careful end-of-life management.

Indexed as

Diabetes Mellitus, Type 2Hypoglycemic AgentsAgedAged, 80 and overCohort StudiesFemaleHumansMaleMedicareMetforminSulfonylurea CompoundsTerminal CareUnited StatesHypoglycemic AgentsMetforminSulfonylurea Compounds

Identifiers

PMID39746144
PMCPMC11870286

What Socratic holds

Texttitle and abstract
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.