1999-P: Potential Overtreatment among Insulin-Treated U.S. Older Adults with Diabetes, 2015–2023

Introduction and Objective: Guidelines recommend glycemic targets (A1C 7-8%) for most older adults with diabetes. Among insulin users, hypoglycemia risk is particularly elevated. We examined trends in potential overtreatment among insulin-treated US older adults. Methods: Cross-sectional analysis of US adults ≥65 years with diabetes using insulin from NHANES 2015-2018 and 2021-2023. Potential overtreatment was defined as A1C 7.0%. Polypharmacy (≥5 medications) was also assessed. Health status (Good, Intermediate, Poor) was categorized based on comorbidities, functional status, and end-stage conditions. Survey-weighted analysis assessed national estimates and temporal trends. Results: Among 368 insulin-treated older adults (mean age=73.0 years, 52.3% female, 63.9% non-Hispanic White, mean A1C=7.9%), potential overtreatment was present in 23.1% (95% CI: 16.1-30.2%) in 2015-2018 and 32.1% (95% CI: 16.9-47.3%) in 2021-2023 (P=0.24). Prevalence of polypharmacy also remained high and unchanged (87.6% to 88.1%, P=0.92). Overtreatment rates were consistently higher among those with worse health status, with no significant changes (all P0.05; Figure). Conclusion: Potential overtreatment and high medication burden remain prevalent among insulin-treated older adults. One-quarter of them maintained tight glycemic control (A1C 7.0%) despite nearly 90% meeting polypharmacy criteriaTargeted interventions are needed to promote safe deintensification in primary care. Disclosure Y. Hong: None. H. Shao: None. T.M. Johnson: None. R.J. Galindo: Consultant; Ended; Abbott, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Gan Current; Roche Pharmaceuticals, Boehringer Ingelheim International GmbH, Novo Nordisk. M.K. Ali: Consultant; Ended; Eli Lilly and Company, Siemens, Novo Nordisk. A. Kulshreshtha: Advisory Panel; Ended; Novo Nordisk Foundation.