A randomized controlled trial comparing treatment with oral agents and basal insulin in elderly patients with type 2 diabetes in long-term care facilities.
BACKGROUND
Managing hyperglycemia and diabetes is challenging in geriatric patients admitted to long-term care (LTC) facilities.


METHODS
This randomized control trial enrolled patients with type 2 diabetes (T2D) with blood glucose (BG) >180 mg/dL or glycated hemoglobin >7.5% to receive low-dose basal insulin (glargine, starting dose 0.1 U/kg/day) or oral antidiabetic drug (OAD) therapy as per primary care provider discretion for 26 weeks. Both groups received supplemental rapid-acting insulin before meals for BG >200 mg/dL. Primary end point was difference in glycemic control as measured by fasting and mean daily glucose concentration between groups.


RESULTS
A total of 150 patients (age: 79±8 years, body mass index: 30.1±6.5 kg/m(2), duration of diabetes mellitus: 8.2±5.1 years, randomization BG: 194±97 mg/dL) were randomized to basal insulin (n=75) and OAD therapy (n=75). There were no differences in the mean fasting BG (131±27 mg/dL vs 123±23 mg/dL, p=0.06) between insulin and OAD groups, but patients treated with insulin had greater mean daily BG (163±39 mg/dL vs 138±27 mg/dL, p<0.001) compared to those treated with OADs. There were no differences in the rate of hypoglycemia (<70 mg/dL) between insulin (27%) and OAD (31%) groups, p=0.58. In addition, there were no differences in the number of hospital complications, emergency room visits, and mortality between treatment groups.


CONCLUSIONS
The results of this randomized study indicate that elderly patients with T2D in LTC facilities exhibited similar glycemic control, hypoglycemic events and complications when treated with either basal insulin or with oral antidiabetic drugs.


BACKGROUND
ClinicalTrials.gov Identifier: NCT01131052.
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Francisco J
FJ
Pasquel
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Winter
W
Powell
Departments of Biostatistics and Bioinformatics , Rollins School of Public Health, Emory University , Atlanta, Georgia , USA.
Limin
L
Peng
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Theodore M
TM
Johnson
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Shadi
S
Sadeghi-Yarandi
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Christopher
C
Newton
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Dawn
D
Smiley
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Marcos T
MT
Toyoshima
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Pedram
P
Aram
Department of Medicine , Emory University School of Medicine , Atlanta, Georgia , USA.
Guillermo E
GE
Umpierrez
Elderly; Hyperglycemia; Hypoglycemia; Insulin