title: Study of Insulin Requirement Modeling in Hospitalized Elderly Patients with Type 2 Diabetes at a Late Stage of Stepwise Escalation Therapy.
abstract: This study explored the relationships between exogenous insulin requirements and endogenous variables in elderly patients with type 2 diabetes (T2D).
  
  
  
  Patients with T2D 65 years of age or older were enrolled for a short hospitalization period in order to start or change their basal-bolus therapy. The following data were collected: age, sex, diabetes duration, body mass index, glycosylated hemoglobin, estimated glomerular filtration rate (eGFR), and triglyceride (TG) levels.
  
  
  
  Data from 71 elderly T2D patients (31 men/40 women; 75.7 ± 6 years of age) were analyzed by data mining techniques. The total daily dose of insulin (TDI) ranged from 0.24 U/kg to 2.5 U/kg (ratio >1:10). Three clusters of patients were identified: Cluster 1 (n = 22) consisted of older patients (age, 82.05 ± 3.6 years) (P < 0.0001) with a TDI of 0.59 ± 0.21 U/kg/day and lower TG level (1.1 ± 0.4 mmol/L) (P < 0.0001). Cluster 2 (n = 22) consisted of patients with a TDI of 0.71 ± 0.24 U/kg/day with a higher eGFR (75.3 ± 18.8 mL/min) (P < 0.001) and a shorter duration of diabetes (13.6 ± 6.4 years) (P < 0.001). Cluster 3 (n = 27) consisted of patients with a larger proportion of macroangiopathic complications (P < 0.05), having a TDI of 1.31 ± 0.54 U/kg/day, higher TG level (2.2 ± 0.7 mmol/L) (P < 0.001), and lower eGFR (46.3 ± 16 mL/min). The average basal-bolus ratio was 43%/57% with a maximum bolus requirement due to carbohydrate intake at breakfast.
  
  
  
  Insulin requirements in elderly T2D patients vary widely. Age, TG level, and eGFR appeared to be the most predictive factors of TDI. Because of the small sample size, further studies would be required to extrapolate these results.
authors.affiliation: 1 Department of Endocrinology-Diabetology and Nutrition, University Hospital , Reims, France .
authors.forename: Afshan
authors.initials: A
authors.lastname: Nourizadeh-Sedaghati
authors.affiliation: 2 CReSTIC (EA 3804), University of Reims Champagne-Ardenne , Reims, France .
authors.forename: Michel
authors.initials: M
authors.lastname: Herbin
authors.affiliation: 1 Department of Endocrinology-Diabetology and Nutrition, University Hospital , Reims, France .
authors.forename: Céline
authors.initials: C
authors.lastname: Lukas-Croisier
authors.affiliation: 3 Department of Geriatric Medicine, University Hospital , Reims, France .
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Novella
authors.affiliation: 1 Department of Endocrinology-Diabetology and Nutrition, University Hospital , Reims, France .
authors.forename: Brigitte
authors.initials: B
authors.lastname: Delemer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D011446:Prospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin