Abstract
Background: Older patients with diabetes require a provider to consider health status and the ability to self-manage with concomitant morbidities. Careful insight into pharmacotherapy regimens that offer the best profile with appropriate efficacy is critical. Diabetes is a common disorder that is often undertreated in the elderly because of the concern for hypoglycemia. A review of the literature and if newer basal insulin formulations cause less hypoglycemia was assessed.
Methods: We reviewed published society guidelines for older patients with diabetes targeting specific A1C treatment goals. The pharmacokinetic and pharmacodynamic profiles of two new basal insulin therapies and their use in older populations were also evaluated. The overall experience with hypoglycemia and the action profile of newer basal insulins, including insulin degludec and concentrated insulin glargine, are described.
Results: Goals for A1C in older adults should be individualized based on patient characteristics and factors including chronic illnesses, activities of daily living, cognitive impairment and life expectancy. In older patients, intensive insulin dosing may be challenging due to a higher risk of hypoglycemia. Newer basal insulin therapies provide a safe option for daily dosing of insulin and less hypoglycemia compared to traditional insulin choices.
Conclusion: Diabetes is a common disorder among the elderly and insulin is a viable therapy that has to be individualized and adequately monitored to prevent untoward risks of hypoglycemia. Newer basal insulins, if affordable for the patient, offer another choice for therapy.
Keywords: Older patients, A1C goal, diabetes, and basal concentrated Insulin.
Graphical Abstract
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