Challenges and Strategies for Inpatient Diabetes Management in Older Adults
Article Figures & Tables
Figures
- FIGURE 1
Management approach for inpatient hyperglycemia in elderly patients with type 2 diabetes in the non-ICU setting. *Basal insulin glargine, detemir, or degludec once daily starting at 0.1 unit/kg/day and adjusting as needed to achieve target blood glucose. **Reduce home insulin dose by 25% on admission if patient is eating or by 50% if patient has poor oral intake. Basil, basil insulin; BG, blood glucose; d, day; DPP4i, DPP-4 inhibitor; prandial, prandial insulin; U, units.
Tables
- TABLE 1
Most Recent Professional Societies’ Recommendations on Inpatient Glycemic Targets for Older Patients
Society, Year (reference) Critically Ill, mg/dL Noncritically Ill, mg/dL Notes Regarding Older Patients Fasting Postprandial ADA/AACE, 2009 (18) 110–180 100–140 100–180 No specific recommendations for older patients International Diabetes Federation, 2014 (22) — <140 <180 These targets are for older patients. Diabetes Canada, 2018 (21) 110–180 90–140 <180 No specific recommendations for older patients Endocrine Society, 2019 (23) — 100–140 140–180 These targets are for older patients. Joint British Diabetes Societies for Inpatient Care, 2019 (24) 140–180 140–180 100–216 mg/dL (6–12 mmol/L) is acceptable for older patients. American Diabetes Association, 2020 (19) 140–180 140–180 No specific recommendations for older patients; >180 mg/dL (10.0 mmol/L) in patients with severe comorbidities - TABLE 2
Framework for an Individualized Approach to the Pre-Discharge Evaluation of Older, Hospitalized Patients With Diabetes
1. Evaluate for geriatric syndrome: • Depression • Urinary incontinence • Fall risk • Vision/hearing problems 2. Avoid polypharmacy. 3. Set outpatient A1C target. 4. Avoid complexity of antihyperglycemic regimen. 5. Reassess regarding whether metformin can be continued or initiated. 6. Reduce the risk of hypoglycemia: • Limit use of sulfonylurea medications. • Use physiologic insulin regimens. • Prefer use of only basal insulin in the early phases of hyperglycemia correction. • Consider a DPP-4 inhibitor instead of initiation or escalation of insulin in patients with an A1C <9.0%. 7. Provide close follow-up in outpatient setting.
In this Issue
August 2020, 33(3)
Challenges and Strategies for Inpatient Diabetes Management in Older Adults
