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When oral agents fail: optimizing insulin therapy in the older adult.
Consult Pharm. 2009 Jun; 24 Suppl B:11-7.CP

Abstract

OBJECTIVES

To evaluate strategies for managing older adults with type 2 diabetes who are inadequately controlled on oral agents and to consider when and how to transition older adults from usual care with oral agents to insulin therapy or incretin-based therapy.

DATA SOURCES

Live symposium presentation based on clinical practice and research, medical literature, and studies published between November 1999 and November 2008 on managing diabetes in older adults, government statistics, and medical society guidelines.

STUDY SELECTION

A study selection was performed using the following search terms: Basal Insulin, Diabetes, Elderly, Incretins, Insulin, Insulin Pharmacokinetics, Long-Term Care, Long-Term Complications, Medications, Oral antidiabetic, Senior, Treatment Goals. Articles were identified from various data sources containing information relevant to the early initiation of insulin and incretin-based drugs in the elderly as well as goals and treatment options in this group.

DATA EXTRACTION

Data were extracted by the author and Nicole Cooper (DesignWrite, LLC).

DATA SYNTHESIS

Recent guidelines suggest the need for early initiation of insulin in patients who fail to achieve or maintain goals on one or more oral agents. Basal-insulin therapy is convenient and appropriate for many older individuals who fail one or more oral agents. Prandial insulin coverage with basal-bolus insulin therapy or premixed insulin therapy may be useful in patients with significant postprandial hyperglycemia. Patients who need postprandial control also may benefit from using a glucagon-like peptide-1 (GLP-1) analog or a dipeptidyl peptidase-4 (DPP-4) inhibitor because they are unlikely to cause hypoglycemia, but reductions in hyperglycemia with these agents are limited.

CONCLUSION

Basal insulin therapy, basal-bolus insulin therapy, and premixed insulin therapy are useful options for older patients inadequately controlled on one or more oral agents. Older patients who require additional postprandial control may benefit from GLP-1 analogs or DPP-4 inhibitors. Additional research is needed to determine optimal therapy in older adults treated with oral agents who require more intensive therapy.

Authors+Show Affiliations

Plaza Pharmacy and Wellness Center, Gainesville, Texas 76240, USA. jmeece12@cooke.net

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19555131

Citation

Meece, Jerry. "When Oral Agents Fail: Optimizing Insulin Therapy in the Older Adult." The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists, vol. 24 Suppl B, 2009, pp. 11-7.
Meece J. When oral agents fail: optimizing insulin therapy in the older adult. Consult Pharm. 2009;24 Suppl B:11-7.
Meece, J. (2009). When oral agents fail: optimizing insulin therapy in the older adult. The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists, 24 Suppl B, 11-7.
Meece J. When Oral Agents Fail: Optimizing Insulin Therapy in the Older Adult. Consult Pharm. 2009;24 Suppl B:11-7. PubMed PMID: 19555131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - When oral agents fail: optimizing insulin therapy in the older adult. A1 - Meece,Jerry, PY - 2009/6/27/entrez PY - 2009/7/30/pubmed PY - 2009/8/14/medline SP - 11 EP - 7 JF - The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists JO - Consult Pharm VL - 24 Suppl B N2 - OBJECTIVES: To evaluate strategies for managing older adults with type 2 diabetes who are inadequately controlled on oral agents and to consider when and how to transition older adults from usual care with oral agents to insulin therapy or incretin-based therapy. DATA SOURCES: Live symposium presentation based on clinical practice and research, medical literature, and studies published between November 1999 and November 2008 on managing diabetes in older adults, government statistics, and medical society guidelines. STUDY SELECTION: A study selection was performed using the following search terms: Basal Insulin, Diabetes, Elderly, Incretins, Insulin, Insulin Pharmacokinetics, Long-Term Care, Long-Term Complications, Medications, Oral antidiabetic, Senior, Treatment Goals. Articles were identified from various data sources containing information relevant to the early initiation of insulin and incretin-based drugs in the elderly as well as goals and treatment options in this group. DATA EXTRACTION: Data were extracted by the author and Nicole Cooper (DesignWrite, LLC). DATA SYNTHESIS: Recent guidelines suggest the need for early initiation of insulin in patients who fail to achieve or maintain goals on one or more oral agents. Basal-insulin therapy is convenient and appropriate for many older individuals who fail one or more oral agents. Prandial insulin coverage with basal-bolus insulin therapy or premixed insulin therapy may be useful in patients with significant postprandial hyperglycemia. Patients who need postprandial control also may benefit from using a glucagon-like peptide-1 (GLP-1) analog or a dipeptidyl peptidase-4 (DPP-4) inhibitor because they are unlikely to cause hypoglycemia, but reductions in hyperglycemia with these agents are limited. CONCLUSION: Basal insulin therapy, basal-bolus insulin therapy, and premixed insulin therapy are useful options for older patients inadequately controlled on one or more oral agents. Older patients who require additional postprandial control may benefit from GLP-1 analogs or DPP-4 inhibitors. Additional research is needed to determine optimal therapy in older adults treated with oral agents who require more intensive therapy. SN - 0888-5109 UR - https://www.unboundmedicine.com/medline/citation/19555131/When_oral_agents_fail:_optimizing_insulin_therapy_in_the_older_adult_ L2 - https://medlineplus.gov/diabetesmedicines.html DB - PRIME DP - Unbound Medicine ER -