Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia

Munshi, Medha N.; Slyne, Christine; Segal, Alissa R.; Saul, Nora; Lyons, Courtney; Weinger, Katie

doi:10.1001/jamainternmed.2016.2288

Cited by 91 publications

(84 citation statements)

References 6 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The lost opportunity to simplify regimens is possibly due to the lack of guidance or algorithm that directs nonspecialist clinicians who care for the majority of these frail older patients with diabetes. We have developed a simplification algorithm that can be used to de-intensify complex insulin regimens by continuing basal insulin and replacing mealtime insulin with noninsulin agents (53). The simplification regimen in this study led to decreased duration of hypoglycemia in these patients without compromising glycemic control.…”

Section: Treatment Strategiesmentioning

confidence: 99%

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

2017

Self Cite

View full text Add to dashboard Cite

One of the challenges of managing older adults with diabetes is the individualization of care in people with multiple comorbid conditions. Although macrovascular and microvascular complications of diabetes are well recognized, there is a lack of awareness regarding other conditions such as cognitive dysfunction, depression, and physical disabilities. Cognitive dysfunction is of particular importance because of its impact on self-care and quality of life. In this Perspective, I discuss common and practical questions faced by clinicians managing diabetes in older adults who also have cognitive dysfunction.

show abstract

Section: Treatment Strategiesmentioning

confidence: 99%

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, it has been demonstrated that simplification of the insulin regimen in older people with type 2 diabetes by switching multiple-dose insulin regimens to once-a-day glargine U-100 with or without noninsulin antihyperglycemic agents results in equivalent glycemic control and a reduced risk of hypoglycemia (186). This strategy should be more broadly applied in older people with multiple comorbidities and/or frailty.…”

Section: Insulin Therapymentioning

confidence: 99%

Diabetes in Older People

Meneilly¹,

Knip²,

Miller³

et al. 2018

Canadian Journal of Diabetes

View full text Add to dashboard Cite

“…Moreover, several studies have demonstrated or reported that acute hyperglycemia (5, 6, 9, 23, 27) or hypoglycemia (7, 25, 32, 41) can result in increased atherothrombotic mechanisms, reduced fibrinolytic balance, and impaired endothelial function in both nondiabetic and diabetic individuals (6, 10, 25, 32, 37). Despite recent data reporting the acute effects of hyperglycemia and hypoglycemia on pro-atherothrombotic responses, only one study has compared their relative effects in humans (9).…”

Section: Introductionmentioning

confidence: 99%

Comparative effects of acute hypoglycemia and hyperglycemia on pro-atherothrombotic biomarkers and endothelial function in non-diabetic humans

Joy¹,

Perkins²,

Mikeladze³

et al. 2016

Journal of Diabetes and its Complications

View full text Add to dashboard Cite

Background The comparative effects of acute moderate hyperglycemia and hypoglycemia on in-vivo endothelial function together with pro-inflammatory and pro-atherothrombotic responses in healthy individuals have not been determined. Methods To investigate this question 45 healthy subjects were compared during glucose clamp studies consisting of euinsulinemic hyperglycemia and hyperinsulinemic hyperglycemia (plasma glucose 11.1 mmol/L, both with pancreatic clamps) and hyperinsulinemic euglycemia and hyperinsulinemic hypoglycemia (plasma glucose 5.1 and 2.9 mmol/L, respectively). Two D doppler ultrasound was used to determine brachial artery endothelial function. Results Insulin levels during euinsulinemia hyperglycemia were 194±23 and (850±49–988±114) pmol/L during all hyperinsulinemic protocols. Responses of VCAM-1, ICAM-1, E-Selectin, P-selectin, PAI-1, and IL-6 were increased (p<0.05-0.0001) during euinsulinemic hyperglycemia or hypoglycemia as compared to hyperinsulinemic euglycemia or hyperinsulinemic hyperglycemia. PAI-1 was increased (p<0.04) during hypoglycemia as compared to euinsulinemic hyperglycemia, TNF-α responses were also increased during hypoglycemia as compared to hyperinsulinemic euglycemia or hyperinsulinemic hyperglycemia (p<0.05). In vivo endothelial function was similarly blunted by acute moderate hyperglycemia or hypoglycemia. Conclusion In summary, acute moderate hypoglycemia and euinsulinemic hyperglycemia can result in similar endothelial dysfunction and pro-atherothrombotic responses. Fibrinolytic balance was reduced by a greater extent by hypoglycemia as compared to moderate hyperglycemia. Acutely, hyperinsulinemia can prevent the acute pro-atherothrombotic and pro-inflammatory effects of moderate hyperglycemia but not hypoglycemia.

show abstract

Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia

Cited by 91 publications

References 6 publications

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know

Diabetes in Older People

Comparative effects of acute hypoglycemia and hyperglycemia on pro-atherothrombotic biomarkers and endothelial function in non-diabetic humans

Contact Info

Product

Resources

About