Insulin use in elderly adults: risk of hypoglycemia and strategies for care.

Abstract

Hypoglycemia is a significant problem in elderly adults with diabetes mellitus. Elderly individuals with diabetes mellitus are at greater risk than younger adults for hypoglycemic events. Several factors contribute to this risk, including the high prevalence of comorbidities, polypharmacy, cognitive impairment, and concomitant use of agents that interfere with glucose metabolism. To minimize the risk of hypoglycemia and maximize the benefits of glycemic control, guidelines typically recommend individualizing glycosylated hemoglobin (HbA1c) targets based on life expectancy, functional status, and individual goals. Although many individuals with type 2 diabetes mellitus will ultimately require insulin therapy to achieve and maintain glycemic control, earlier insulin initiation in elderly individuals may be warranted, particularly in those with renal, cardiovascular, or hepatic concerns that could interfere with the use of oral agents. There are few data on the use of insulin-or other glucose-lowering agents-in elderly adults, but limited evidence suggests that the use of insulin, especially insulin analogs, may be appropriate in this population. Insulin analogs offer a better pharmacokinetic profile, greater convenience, and less variable glycemic control than human insulin. Because of the high prevalence of cognitive impairment and other geriatric syndromes in elderly adults, clinicians should perform a comprehensive assessment of patients' ability to administer and monitor insulin therapy and recognize and treat hypoglycemia.

• Authors: Robert J Ligthelm, Marcel Kaiser, Jiten Vora, Jean-François Yale
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 60 Issue 8 Pg. 1564-70 (Aug 2012) ISSN: 1532-5415 [Electronic] United States
• PMID: 22881394 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Chemical References

• Hypoglycemic Agents
• Insulin

Topics

• Aged
• Diabetes Mellitus (drug therapy)
• Humans
• Hypoglycemia (chemically induced)
• Hypoglycemic Agents (adverse effects)
• Insulin (adverse effects)