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.