0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letter |

Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia

Medha N. Munshi, MD1,2,3; Christine Slyne, BA1; Alissa R. Segal, PharmD1,4; Nora Saul, RD1; Courtney Lyons, RN1; Katie Weinger, EdD1,3
[+] Author Affiliations
1Joslin Diabetes Center, Boston, Massachusetts
2Beth Israel Deaconess Medical Center, Boston, Massachusetts
3Department of Medicine, Harvard Medical School, Boston, Massachusetts
4School of Pharmacy, MCPHS University, Boston, Massachusetts
JAMA Intern Med. 2016;176(7):1023-1025. doi:10.1001/jamainternmed.2016.2288.
Text Size: A A A
Published online

Extract

This case series describes HbA1c levels and frequency of hypoglycemia among older patients with type 2 diabetes whose treatment regimen was simplified to once-a-day glargine with or without noninsulin agents.

Hypoglycemia is a serious adverse event, especially in older patients with diabetes, and is associated with poor outcomes.1 Intensive insulin regimens add a large burden of self-care to older patients and increase the risk of hypoglycemia.2,3 Treatment guidelines and expert consensus recommend deintensification of treatment regimens in older adults.4 However, the effect of insulin regimen simplification on the risk of hypoglycemia or uncontrolled hyperglycemia is not known. In addition, the lack of an algorithm to guide insulin regimen simplification may account for missed opportunities to deintensify insulin regimens in older patients with diabetes.5

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure.
Algorithm for Insulin Regimen Simplification

Insulin regimen simplification is achieved in this algorithm by changing to or adding glargine as basal insulin and adding noninsulin agents to replace meal-time insulins. Long-acting insulins include insulin detemir (Levemir; Novo Nordisk) and Neutral Protamine Hagedorn insulin. Meal-time insulins include insulin lispro (Humalog; Lilly), insulin aspart (NovoLog; Novo Nordisk), and insulin glulisine (Apidra; Sanofi-Aventis) All patients were 65 years or older with type 2 diabetes, took 2 or more insulin injections/d, and had at least 1 episode of hypoglycemia (glucose level <70 mg/dL) during a 5-day period of continuous glucose monitoring.

aManagement of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (http://www.ncbi.nlm.nih.gov/pubmed/25538310). Further simplification agents were chosen based on risk of hypoglycemia, cost, adverse-effect profile, effect on weight, and effectiveness, as recommended.

bIf fasting glucose levels are higher than the goal but prelunch or dinner glucose levels reach the goal, change the glargine dose to bedtime at the same dose.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,352 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();