# Diabetes Treatments and Hypoglycemic-Related Adverse Events in Nursing Home Residents

> **NIH NIH R21** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2020 · $251,250

## Abstract

PROJECT SUMMARY/ABSTRACT
The National Institute of Health report Diabetes in America (2018) noted that 39.5% of adults with diabetes are
aged ≥ 65 years, and the prevalence of diabetes in older adults is dramatically increasing. Management of
diabetes in older adults in nursing homes is challenging due to this population having heterogeneous comorbid
medical conditions, and associated medications, many of which are contraindicated for common antidiabetic
drugs. Intensive diabetes management in older adults is associated with an increased risk of hypoglycemia. Drug
induced hypoglycemia is the 3rd most common adverse drug event among hospitalized Medicare beneficiaries.
Hypoglycemia is experienced by 18% to 40% of nursing home residents. There is a lack of observational or
clinical evidence pertaining to antidiabetic treatments in long-term care nursing home residents, despite this
population being at high risk for diabetes, diabetes-related complications, and adverse effects of antidiabetic
drugs. The American Diabetes Association’s consensus report on diabetes in older adults noted that “There are
essentially no directly applicable clinical trial data on glucose control for large segments of the older diabetic
patient population.” Furthermore, there are few real-world studies of antidiabetic treatments in nursing home
residents. In recognition of this knowledge gap in this high-risk population, the Diabetes Mellitus Interagency
Coordinating Committee, as reported in the NIDDK Recent Advances & Emerging Opportunities (2019), issued
a call for studies that increase our understanding of diabetes treatments in long-term care settings, with a
particular emphasis on the need to understand the impact of cognitive and functional impairments,
multimorbidity, polypharmacy, and risk of hypoglycemia. These priorities are central to our proposed scope of
research. Using the Federally-mandated Minimum Data Set 3.0, linked to Medicare Part A and D claims, the
aims are to: 1) characterize antidiabetic treatment practices among nursing home residents; 2) identify and
describe clinically relevant phenotypes of diabetic nursing home residents based on patterns of
cognitive/functional impairments, comorbidities, and treatment procedures/medications, and 3) estimate the
occurrence of hospitalizations (overall, hypoglycemia-related, and hypoglycemia-specific) by propensity-
matched patterns of antidiabetic treatments, across resident phenotypes. We hypothesize that risks associated
with antidiabetic treatments will be heterogeneous across resident phenotypes. We anticipate that the phenotypic
approach we propose will serve as a foundation for future work to conduct phenotypic-specific comparative
effectiveness research in support of evidence-based personalized antidiabetic treatment recommendations.

## Key facts

- **NIH application ID:** 9957331
- **Project number:** 1R21NR019160-01
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Anthony P Nunes
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $251,250
- **Award type:** 1
- **Project period:** 2020-04-03 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9957331

## Citation

> US National Institutes of Health, RePORTER application 9957331, Diabetes Treatments and Hypoglycemic-Related Adverse Events in Nursing Home Residents (1R21NR019160-01). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9957331. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*