Insulin Therapy in the Elderly Patient With Diabetes

Background: Most elderly patients with type 2 diabetes require, or will eventually require, insulin to achieve or maintain their glycemic goals. However, insulin therapy remains underused in this population. Objective: The goal of this review is to evaluate the role of insulin therapy in elderly patients and identify strategies to improve its use in this patient population. Methods: Searches of the MEDLINE and EMBASE databases were conducted to identify papers published in English between January 1990 and March 2010. The following search terms were used: diabetes mellitus, insulin, elderly, geriatric, analog, premix, pen device, and human insulin. Papers selected for review included meta-analyses, randomized controlled trials of insulin therapy, or evidence-based reviews and/or expert opinion regarding the use of insulin in elderly patients with diabetes. Results: Insulin therapy is the most effective antidiabetic agent when appropriately dosed; however, only a minority of elderly patients with diabetes uses it. Although there are few randomized controlled studies on insulin use in the elderly, an individualized approach to insulin therapy is recommended to account for varying clinical and practical factors that affect diabetes care in this patient population. Therapy with insulin analogs offers several advantages compared with human insulin regimens, including a more physiologic pharmacologic profile, increased convenience, and a reduced risk of hypoglycemia, which may make them particularly attractive in older adults. Premixed insulin analog therapy may provide added convenience, as well as improved glycemic control. Insulin pen devices are also recommended to facilitate insulin dosing and help patients maintain their independence. Conclusions: The improved clinical profiles of insulin analogs and the ease of use of newer insulin delivery devices may be advantageous in elderly patients with diabetes; however, additional research on the efficacy and safety of insulin regimens is urgently needed. (Am J Geriatr Pharmacother. 2011;9:24-36) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.