Diabetes medication use in the last year of life in people living with dementia in the United Kingdom and Australia.

PURPOSE: To investigate the prevalence of type 2 diabetes (T2D) medication use in the final 3,6, 9, and 12 months of life and explore patient factors associated with discontinuation in the 6 months prior to death in people living with dementia in the UK and Australia. METHODS: Linked hospital and administrative data were used from the UK and Australia. We included individuals who died between July 2013 and June 2018. Logistic regressions estimated the association between age, sex, cardiovascular disease, chronic kidney disease (CKD), and cancer with discontinuation of T2D medications. RESULTS: 10,088 UK and 6,436 Australian individuals were identified. From those supplied insulin in the last 12 months of life, there was a 25.6% reduction in use in the UK and 43.5% in Australia in the last 3 months of life, but minimal reduction in other medication classes. CKD was associated with metformin discontinuation in the last 6 months of life in the UK (OR 1.05, 95% CI 1.03-1.07) and Australia (OR 1.60, 95% CI 1.15-2.12). CONCLUSION: Guideline-concordant discontinuation of metformin in the last 6 months of life was observed in those with CKD. Decreased insulin supply in those living with dementia was observed. There were lower rates of discontinuation of other glucose-lowering medications in the UK and Australia.