title: Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study.
abstract: BACKGROUND
  The management of type 2 diabetes mellitus in long-term care (LTC) settings can be complex as a result of age-related complications. Despite guideline recommendations, sliding scale insulin remains commonplace in the LTC setting and data on basal insulin use are lacking.
  
  
  METHODS
  This retrospective study used medical chart data and the Minimum Data Set from elderly LTC facility patients who received basal insulin (insulin glargine, insulin detemir, or neutral protamine Hagedorn insulin) for the treatment of diabetes, to investigate the practice patterns and associated clinical outcomes.
  
  
  RESULTS
  A total of 2,096 elderly, insulin-treated patients in LTC were identified, with 59.5% of them (N=1,247) receiving basal insulin. Of these, more than 50% of patients received sliding scale insulin in co-administration with basal insulin. Despite its ease of use, insulin pen use was very low, at 14.6%. Significant differences were observed between the basal insulin groups for glycated hemoglobin level and dosing frequency. Hypoglycemia was uncommon -17.2% of patients experienced at least one event, and there was no significant difference in the prevalence of hypoglycemia between the groups.
  
  
  CONCLUSIONS
  These data suggest the underutilization of basal insulin in the LTC setting and worryingly high combinational use with sliding scale insulin. Differences in glycated hemoglobin and dosing frequencies between types of basal insulin warrant further comparative effectiveness studies.
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Keith L
authors.initials: KL
authors.lastname: Davis
authors.affiliation: Sanofi US, Inc, Bridgewater, NJ, USA.
authors.forename: Wenhui
authors.initials: W
authors.lastname: Wei
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Juliana L
authors.initials: JL
authors.lastname: Meyers
authors.affiliation: AnalytiCare, LLC, Glenview, IL, USA.
authors.forename: Brett S
authors.initials: BS
authors.lastname: Kilpatrick
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
authors.forename: Naushira
authors.initials: N
authors.lastname: Pandya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006442:Glycated Hemoglobin; D006707:Homes for the Aged; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007279:Injections, Subcutaneous; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000009:adverse effects / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D009735:Nursing Homes; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D007336:Insulin, Isophane; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human
keywords: NPH insulin; insulin detemir; insulin glargine; long-term care; nursing homes; type 2 diabetes mellitus