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Our aim was to examine the incidence and predictors of diabetes medication deintensification in older Veterans with LLE\/AD who were potentially overtreated at admission to Veterans Affairs (VA) nursing homes (community living centers [CLCs]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>Retrospective cohort study using linked VA and Medicare clinical\/administrative data and Minimum Data Set assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING<\/jats:title>\n                    <jats:p>VA CLCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PARTICIPANTS<\/jats:title>\n                    <jats:p>A total of 6960 Veterans with diabetes and LLE\/AD admitted to VA CLCs in fiscal years 2009 to 2015 with hemoglobin (Hb)A1c measured within 90\u2009days of admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS<\/jats:title>\n                    <jats:p>We evaluated treatment deintensification (discontinuation or dose reduction for a consecutive 7\u2010day period) among residents who were potentially overtreated (HbA1c\u2009\u22647.5% and receiving hypoglycemic medications). Competing risk models assessed 90\u2010day cumulative incidence of deintensification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>More than 40% (n = 3056) of Veteran CLC residents with diabetes were potentially overtreated. The cumulative incidence of deintensification at 90\u2009days was 45.5%. Higher baseline HbA1c values were associated with a lower likelihood of deintensification (e.g., HbA1c 7.0\u20107.5% vs &lt;6.0%; adjusted risk ratio [aRR] = .57; 95% confidence interval [CI] = .50\u2010.66). Compared with non\u2010sulfonylurea oral agents (e.g., metformin), other treatment regimens were more likely to be deintensified (aRR = 1.31\u20101.88), except for basal insulin (aRR = .59; 95% CI = .52\u2010.66). The only resident factor associated with increased likelihood of deintensification was documented end\u2010of\u2010life status (aRR = 1.12; 95% CI = 1.01\u20101.25). Admission from home\/assisted living (aRR = .85; 95% CI = .75\u2010.96), obesity (aRR = .88; 95% CI = .78\u2010.99), and peripheral vascular disease (aRR = .90; 95% CI = .81\u2010.99) were associated with decreased likelihood of deintensification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>\n                      Deintensification of treatment regimens occurred in less than one\u2010half of potentially overtreated Veterans and was more strongly associated with low HbA1c values and use of medications with high risk for hypoglycemia, rather than other resident characteristics.\n                      <jats:bold>J Am Geriatr Soc 68:736\u2013745, 2020<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.16360","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T05:26:40Z","timestamp":1581917200000},"page":"736-745","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Deintensification of Diabetes Medications among Veterans at the End of Life in VA Nursing Homes"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-5751","authenticated-orcid":false,"given":"Joshua D.","family":"Niznik","sequence":"first","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"},{"name":"Division of Geriatric Medicine University of North Carolina School of Medicine  Chapel Hill North Carolina"},{"name":"Division of Pharmaceutical Outcomes and Policy University of North Carolina Eshelman School of Pharmacy  Chapel Hill North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob N.","family":"Hunnicutt","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria K.","family":"Mor","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"},{"name":"Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florentina","family":"Sileanu","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1342-6938","authenticated-orcid":false,"given":"Sherrie L.","family":"Aspinall","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"},{"name":"VA Center for Medication Safety  Hines Illinois"},{"name":"University of Pittsburgh School of Pharmacy  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydney P.","family":"Springer","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"},{"name":"University of New England College of Pharmacy  Portland Maine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0520-311X","authenticated-orcid":false,"given":"Mary J.","family":"Ersek","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs (VA) Pittsburgh Healthcare System  Pittsburgh Pennsylvania"},{"name":"Veterans Experience Center; Corporal Michael J. 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