Do Age and Comorbidity Affect Intensity of Pharmacological Therapy for Poorly Controlled Diabetes Mellitus?

OBJECTIVES: To examine the influence of age and comorbidity on intensification of medical therapy for patients with poorly controlled diabetes mellitus (DM). DESIGN: Observational cohort study using data from Department of Veterans Affairs (VA) national databases. SETTING: Thirteen VA medical centers in New England, Florida, and Puerto Rico. PARTICIPANTS: Veterans (N=5,317) with poorly controlled DM receiving regular medical care MEASUREMENTS: An increase in hypoglycemic medications, or intensification of therapy, was considered present at the visit if a new hypoglycemic medication was started or the dosage of an existing medication was increased. RESULTS: The overall rate of intensification of therapy was 20.8% (1,106/5,317). The rate of intensification was highest in the youngest patients without comorbidity (24.5%) and lowest in the oldest patients with comorbidity (15.7%) (P<.001). CONCLUSION: Rates of intensification at a single clinic visit were quite low in all groups and were lowest in older patients with comorbidity.