Minimizing the risk of hypoglycemia in older adults: a focus on long-term care.

OBJECTIVES: To consider the risk and impact of hypoglycemia in older adults with type 2 diabetes (T2DM), to describe how to interpret blood glucose readings in an older patient's medical record, and to discuss strategies for avoiding hypoglycemia in this patient population.

DATA SOURCES: Live symposium presentation based on clinical practice and research, medical literature, and studies published between January 1990 and November 2008 on managing T2DM in older adults, government statistics, and medical society guidelines.

STUDY SELECTION: A literature search was performed. Search terms included: Diabetes, Elderly, Hypoglycemia, Insulin Pattern Management, Long-Term Care, Senior, Sliding Scale Insulin. Twenty-two articles were identified from various sources containing information relevant to the identification and treatment of hypoglycemia in elderly persons with diabetes.

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

DATA SYNTHESIS: Numerous studies have demonstrated the benefits of achieving near-normal levels of glycemic control in patients with T2DM. However, avoiding hypoglycemia during intensive therapy can be challenging for older adults and may present a barrier to glycemic control in this population. Pharmacists working in long-term care settings can take several steps to help their older patients avoid hypoglycemia, including recommending the use of insulin regimens with more physiologic time-action profiles, such as insulin analogs. They also can help facilities develop protocols for treating hyperglycemia and hypoglycemia, offer insulin pattern management services, and help educate the staff about the optimal use of insulin therapies.

CONCLUSIONS: Consultant pharmacists can play a critical role in preventing hypoglycemia in long-term care facilities by recommending the use of more physiologic insulin regimens, developing facility protocols for glycemic management, and providing staff education.