Varying insulin use in older hospitalized patients with diabetes.
OBJECTIVE
Observation of insulin use in consecutive hospitalized diabetic older patients in acute care wards with reference to nutritional intakes, measures of functional status, and varying clinical situations.


METHODS
Prospective case study in a geriatric medicine ward with CGA, dietary intake measure and used insulin dosage.


RESULTS
Among 600 inpatients, 90 diabetic subjects were found. Only 12.2 % diabetic patients had MMSE > 23 and 23.3% were unable to eat without assistance. During the stay 54 patients had received insulin. From admission to discharge or death, doses were 0.39 to 0.19 U/kg (SD 0.41-0.15) during palliative care, 0.43 to 0.45 U/kg (SD 0.20-0.20) in the event of failure of oral therapy, 0.38 to 0.42 U/kg (SD 0.18-0.25) if creatinine clearance was 30 ml/min or lower, and 0.38 to 0.27 U/kg (SD 0.24-0.26) in critical diseases. Dietary intake increased in all during the stay with an energy intake close to 20 kCal/kg/d at discharge, except for those in palliative care, who had a final intake of 8.2 kCal/kg/d (SD 9.1).


CONCLUSIONS
Insulin treatment guidelines adapted to this frail diabetic population are necessary.
Jover
N
N
Department of Gerontology, CHU Bordeaux, France.
Traissac
T
T
Pinganaud
G
G
Moras
J-B
JB
Rainfray
M
M
Bourdel-Marchasson
I
I
D000369:Aged, 80 and over; D000704:Analysis of Variance; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D004363:Drug Utilization; D002149:Energy Intake; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000097:blood / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies
D007004:Hypoglycemic Agents; D007328:Insulin; D003404:Creatinine