Diabetes in the Elderly: Prospective Study
Diabetes in the Elderly: Prospective Study
Diabetes is highly prevalent in the elderly, afflicting about 20% of older adults aged 65-75
 years and 40% of adults >80years of age. It is expected that the number of elderly people
 suffering from diabetes will increase in the future, as general life expectancy is
 increasing.

 Nursing home residents with diabetes have higher rates of serious comorbidities and have
 greater activity of daily living dependencies than other residents without diabetes. In
 addition, persons with diabetes have higher risk of hypertension, heart disease, stroke
 depression, cognitive impairment, and cardiovascular mortality than individuals without
 diabetes.

 There are a few retrospective studies in elderly patients analyzing quality of diabetes care
 and glycemic control adjusted for medications and presence of co-morbidities in long-term
 care facilities; however, no previous randomized controlled trials have demonstrated benefits
 of glycemic control on clinical outcome, quality of life, and rate of acute metabolic
 complications (hyperglycemia and hypoglycemic events) in long-term care facilities. In
 addition, it is not known whether the use of basal insulin is superior to treatment with
 sliding scale insulin (SSI) in long-term care facility residents with type 2 diabetes.

 Accordingly, the investigators propose to conduct a prospective randomized control trial
 comparing the efficacy and safety of the basal (glargine) insulin regimen and sliding scale
 regular insulin in the management of nursing home patients with T2DM.
Inclusion Criteria:

 1. Males or females > 60 years of age.

 2. Blood glucose > 150 mg/dl and A1C > 7.5%.

 3. A known history of T2DM, receiving either diet alone, oral monotherapy, or with any
 combination of oral antidiabetic agents (metformin, sulfonylureas, repaglinide,
 nateglinide, pioglitazone, rosiglitazone, sitagliptin).

 4. Patients admitted for non-cardiac elective or emergency surgery or trauma.

 Exclusion Criteria:

 1. Subjects with increased blood glucose concentration, but without a known history of
 diabetes (stress hyperglycemia).

 2. Subjects with a history of diabetic ketoacidosis and hyperosmolar hyperglycemic state
 (26).

 3. Patients with clinically relevant hepatic disease (diagnosed liver cirrhosis and
 portal hypertension), corticosteroid therapy, or impaired renal function (creatinine ≥
 3.5 mg/dl).

 4. Patients with recognized or suspected endocrine disorders associated with increased
 insulin resistance, acromegaly, or hyperthyroidism