Continuation status of diabetes medication treatment after entering a nursing home in Japan

This study aimed to investigate the continuity of diabetes treatment as patients transitioned from home to nursing home care in Japan, focusing on treatment changes, particularly the details and timing of changes related to insulin therapy. We analyzed medical claims data from the National Health Insurance and the Latter-stage Elderly Medical Care System as well as long-term care claims data in Ibaraki Prefecture, Japan, covering the period from April 2018 to March 2019. This study included 456 patients with diabetes who transitioned to a nursing home between July and December 2018. Diabetes was identified using ICD-10 codes (E10 to E14), encompassing type 1, type 2, and other forms of diabetes. Treatments were categorized as no medication, oral medication only, insulin only, and a combination of both. This study examined the continuity of and changes in these treatments between the “home care” and “nursing home care” periods and investigated the details of these changes. We analyzed 456 participants, with an average age of 87 years, of whom 70.8% were female. Treatment during the home care period was as follows: 60.1% of patients were on no medication, 30.3% were on oral medication only, 2.0% were on insulin only, and 7.7% were on insulin and oral medication. During the nursing home care period, these proportions changed to 57.5%, 34.4%, 2.2%, and 6.0%, respectively. A total of 83.7% of the patients continued their original treatment after admission, whereas 16.3% experienced changes in their treatment. In the group of 44 insulin users at home, post-admission changes were as follows: 9.1% stopped all diabetes medications, 52.3% switched to oral medications, 13.6% used insulin only, and 25.0% used oral medication and insulin. Notably, 85.7% of the patients stopped using fast-acting insulin in the month of admission. This study found that treatment changes were observed in a certain proportion of patients with diabetes following their move to a nursing home. Insulin was frequently stopped, especially fast-acting insulin. These changes may negatively impact patients’ health if driven by the nursing home’s policies or conditions.