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Tight glycemic control is inappropriate for older patients in poor health who are unlikely to benefit from long-term prevention of complications and who are most likely to suffer adverse hypoglycemic events. In this longitudinal cohort study, Kaiser Permanente researchers explored insulin prescribing patterns by identifying 21,531 older patients (age, >75) with type 2 diabetes. The health status of these patients was labeled as good (51% of the cohort), intermediate (40%), or poor (9%) based on their number of comorbidities, activity levels, and end-stage organ disease status (including metastatic cancer).
At baseline, 4076 (19%) of these patients used insulin. Insulin use was significantly more likely for patients in poor health (adjusted r…