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Review: Diabetes and insulin therapy in older people

Department of Geriatric Medicine, Brearley Wing, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK,Tim, Hendra{at}sth.nhs.uk

Concerns about hypoglycaemia, plus lack of evidence of benefit, contributed to underutilisation of insulin for older people with type 2 diabetes in the past. Following the UKPDS it is clear that many elderly patients treated with diet and oral antidiabetic agents will develop beta-cell failure and will be at risk of worsening glycaemic control with reduced well-being unless insulin is considered. Following diabetes diagnosis, the mainstay of treatment will be dietary control and exercise together with management of cardiovascular risk factors. When glycaemic control deteriorates oral agents will be needed. However, whereas in the past insulin was seen as a last resort for older type 2 patients there is support for considering its early use in selected older people with preserved cognitive function and poor glycaemic control, as well as for frail older people with weight loss and poor quality of life. The regimens of choice may include a combination of basal insulin with oral agents or twice-daily combinations of premixed short and intermediate acting insulin. The development of insulin analogues with their associated reduced risk of hypoglycaemia may also herald a new era of insulin treatment for older people.

Key Words: older people • early use of insulin • quality of life.

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The British Journal of Diabetes & Vascular Disease, Vol. 5, No. 1, 19-23 (2005)
DOI: 10.1177/14746514050050010401


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hendra, T. J Search for Related Content Social Bookmarking                         What's this?