Cardiovascular risk management in the elderly with type 2 diabetes prior to death: A Danish nationwide register study of discontinuation patterns

Abstract

ABSTRACTBackgroundCardioprotective medication usage among elderly individuals with type 2 diabetes (T2D) is prevalent, however, the degree and timing of discontinuation is unknown. This study aims to describe the extent, timing, and secular changes of discontinuation of cardioprotective medication in elderly with T2D.MethodsIn this register-based cohort study all individuals with T2D, deceased between 2006-2018 at an age of 80 years or older, were identified through Danish nation-wide registers. We followed the population backward in time, from death to last intake of antihypertensive, lipid-lowering, and antithrombotic medication. Poisson regression models were used to model rates of discontinuation prior to death while binomial models were used to estimate the proportion on medication at time of death.ResultsWe identified 52,523 individuals (55% women) with a mean (SD) age at T2D diagnosis of 77.3 (7.8) years and median (Q1-Q3) age at death of 86.5 [83.3-90.3] years. The proportion on any antihypertensive and antithrombotic medication was high (approximately 78% [95% CI 77-78] and 48% [95% CI 47-49%] at time of death, respectively) and increased slightly with increasing calendar year of death. Discontinuations occurred predominantly in the last year of life but were initiated earlier for individuals who died in recent calendar years. However, for angiotensin-converting enzyme, thiazides, and acetylsalicylic acid we found a more continuous discontinuation in the decade prior to death in the recent calendar years of death. The proportion on statins increased markedly with calendar year of death, peaking at 34% [95% CI 33-35%] in 2016 with a subsequent decrease to 29% [95% CI 28-30%] in 2018. Discontinuation patterns shifted from predominantly occurring in the last years of life to continues discontinuation in the decade before death.ConclusionOur results suggest an intensification with cardioprotective medication among elderly with type 2 diabetes and a more pronounced discontinuation during the last years of life. This may be a result of increased focus on individualized-treatment-regimens.