As the population ages, so does the frequency of chronic illness such as coronary artery disease, hypertension, or diabetes. Type 2 diabetes mellitus (T2DM) has nearly tripled in prevalence among those older than 75 years.
Areas of Uncertainty:
Renal/hepatic failure, poor nutritional status, limited mobility, and cognitive impairment are some of the factors that can predispose elderly patients to hypoglycemia or hyperglycemia. As a result, the diabetes guidelines have been modified to recommend less stringent glycemic control for this vulnerable population.
In this review, the authors address the inpatient management of type 2 diabetes, in which patients are transitioned off of their oral antihyperglycemic agents and started on insulin therapy. Insulin dosing has to be adjusted in those with changes in renal function, concomitant steroid use, decreased oral intake, or utilization nonenteral nutrition. In addition, there is a discussion of the transition of inpatient insulin therapy to outpatient care. Medication reconciliation is crucial and has a significant impact on the outcome and quality of care. This review examines established and newer agents such as sodium-glucose cotransporter 2 inhibitors and concentrated insulin. Creatinine clearance is an important factor in the dosing of these agents, as elderly patients can have a normal creatinine with a compromised creatinine clearance. Lastly, this review examines the use of the evolving diabetes therapeutic technology: insulin pumps and sensors. These devices are no longer limited to the outpatient settings, as hospitals are devising insulin pump policies that allow patients to continue to use their device. Its role in the elderly population, however, is poorly understood and requires further research for its applicability.
As the prevalence of T2DM continues to rise and population continues to age, inpatient care and care transitions remains an essential key in management of elderly persons with T2DM.