A Danish study highlights that diabetes treatments often remain unchanged during care home admissions, despite shifts in residents’ health status, raising concerns over personalised care for older adults with diabetes.
A nationwide Danish study has found that diabetes treatment in care homes often appears to stay on autopilot, even as residents move into a setting where medication goals may need to change. Published in Diabetes, Obesity and Metabolism and led by Hanin Harbi of the University of Southern Denmark, the research examined all people admitted to Danish care homes between 2018 and 2023 and tracked their glucose-lowering treatment before and after admission.
Among 88,658 residents, with a median age of 84 and 60% women, 13% were using glucose-lowering drugs when they entered care. In that subgroup, the median HbA1c was 6.9%, below the usual target range for many older adults with diabetes, yet treatment intensity changed little around admission. The authors said that pattern suggests there was limited deintensification, despite the shift to a more frail, institutionalised population.
Metformin was the most common medicine, used by 70% of treated residents, followed by insulin at 36% and DPP-4 inhibitors at 19%. Nearly half were taking more than one class of drug. Use of newer agents such as GLP-1 receptor agonists and SGLT2 inhibitors rose over time, reaching 32% in 2023 from 6.9% in 2018, but their use remained modest even among residents with cardiorenal disease. The study found little difference in prescribing between those with and without such disease.
The biggest surge in treatment starts came in the three months before admission, when the rate reached about 36 new starts per 10,000 residents. Most of those prescriptions were written within two weeks of a hospital stay, and many were bolus insulin starts from hospital doctors. That finding matters because it suggests care home admission may follow a period of acute illness or treatment escalation rather than a deliberate review of longer-term diabetes goals.
The broader Danish evidence points to a system that has steadily expanded and intensified diabetes treatment in recent years. Earlier national data published in 2023 showed that overall use of glucose-lowering drugs in adults rose from 2.1% in 2005 to 5.0% in 2021, with greater reliance on metformin, insulin, GLP-1 drugs and SGLT2 inhibitors. Another Danish study found that older adults were less likely than younger patients to receive newer diabetes medicines, underscoring concerns that age may still shape access to treatment. Against that backdrop, Harbi’s team said care home residents need more evidence to support individualised decisions that balance benefit and harm.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
