The increasing prevalence of diabetes among elderly patients underscores the importance of matching the most effective therapy for diabetes self-management with patients' cognitive and motor skills, as these diminish with advancing age. Although many geriatric patients state interest in insulin pump therapy for tight glycemic control, few studies have examined the effectiveness, safety, and feasibility of insulin pumps compared to traditional injected insulin therapy in older age groups. It is important, therefore, for physicians to recognize the indications and the age-related barriers to insulin pump therapy in geriatric patients. Indications include glucose variability, hypoglycemia, and poor glycemic control with traditional insulin regimens. Common barriers include poor vision, dexterity, and cognitive status. Successful implementation of insulin pump therapy for older patients requires an experienced diabetes management team that can assess patient needs and tailor therapy in the context of age-related disabilities.
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References
1.
ResnickHE, HarrisMI, BrockDB, HarrisTB. American Diabetes Association diabetes diagnostic criteria, advancing age, and cardiovascular disease risk profiles: results from the Third National Health and Nutrition Examination Survey. Diabetes Care, 2000; 23:176–180.
2.
U.S. Census Bureau: International Data Base. Table 094. Midyear population, by age and sex. http://www.census.gov/population/www/projections/natdet-D1A.html. 2010 April 9.
3.
MorleyJE. The elderly Type 2 diabetic patient: special considerations. Diabet Med, 1998; 15,Suppl 4:S41–S46.
4.
BrownAF, MangioneCM, SalibaD, SarkisianCA. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc, 2003; 51,5 Suppl Guidelines:S265–S280.
5.
SkylerJS, BergenstalR, BonowRO, BuseJ, DeedwaniaP, GaleEA, HowardBV, KirkmanMS, KosiborodM, ReavenP, SherwinRS. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care, 2009; 32:187–192.
6.
MillerME, BondsDE, GersteinHC, SeaquistER, BergenstalRM, Calles-EscandonJ, ChildressRD, CravenTE, CuddihyRM, DaileyG, FeinglosMN, Ismail-BeigiF, LargayJF, O'ConnorPJ, PaulT, SavagePJ, SchubartUK, SoodA, GenuthS. ACCORD Investigators: The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ, 2010; 340:b5444.
7.
Standards of medical care in diabetes—2010. Diabetes Care, 2010; 33,Suppl 1:S11–S61.
8.
SinclairAJ. Special considerations in older adults with diabetes: meeting the challenge. Diabetes Spectrum, 2006; 19:229–233.
9.
Lassmann-VagueV. Hypoglycaemia in elderly diabetic patients. Diabetes Metab, 2005; 31,Spec No 2:5S53–5S57.
10.
Bourdel MarchassonI, DoucetJ, BauduceauB, BerrutG, BlickleJF, BrockerP, ConstansT, Fagot CampagnaA, KaloustianE, Lassmann VagueV, LecomteP, SimonD, TessierD, VernyC, VischerUM. Key priorities in managing glucose control in older people with diabetes. J Nutr Health Aging, 2009; 13:685–691.
11.
PickupJC, RenardE. Long-acting insulin analogs versus insulin pump therapy for the treatment of type 1 and type 2 diabetes. Diabetes Care, 2008; 31,Suppl 2:S140–S145.
HermansenK, DaviesM, DerezinskiT, Martinez RavnG, ClausonP, HomeP. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care, 2006; 29:1269–1274.
14.
RiddleMC, RosenstockJ, GerichJ. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care, 2003; 26:3080–3086.
15.
HirschIB, BodeBW, GargS, LaneWS, SussmanA, HuP, SantiagoOM, KolaczynskiJW. Continuous subcutaneous insulin infusion (CSII) of insulin aspart versus multiple daily injection of insulin aspart/insulin glargine in type 1 diabetic patients previously treated with CSII. Diabetes Care, 2005; 28:533–538.
16.
DoyleEA, WeinzimerSA, SteffenAT, AhernJA, VincentM, TamborlaneWV. A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care, 2004; 27:1554–1558.
17.
BolliGB, KerrD, ThomasR, TorloneE, Sola-GazagnesA, VitacolonnaE, SelamJL, HomePD. Comparison of a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) in type 1 diabetes: a randomized open parallel multicenter study. Diabetes Care, 2009; 32:1170–1176.
18.
MissoML, EgbertsKJ, PageM, O'ConnorD, ShawJ. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev, 2010; 1:CD005103.
19.
HermanWH, IlagLL, JohnsonSL, MartinCL, SindingJ, Al HarthiA, PlunkettCD, LaPorteFB, BurkeR, BrownMB, HalterJB, RaskinP. A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes. Diabetes Care, 2005; 28:1568–1573.
20.
RizviAA, PetryR, ArnoldMB, ChakrabortyM. Beneficial effects of continuous subcutaneous insulin infusion in older patients with long-standing type 1 diabetes. Endocr Pract, 2001; 7:364–369.
21.
UslanMM, BurtonDM, ChertowBS, CollinsR. Accessibility of insulin pumps for blind and visually impaired people. Diabetes Technol Ther, 2004; 6:621–634.
22.
RizviAA. Benefits of insulin pump therapy in the elderly. Geriatr Times, 2002; 3,3http://cmellc.com/geriatrictimes/g020623.html. 2010 April 9.
23.
CukiermanT, GersteinHC, WilliamsonJD. Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies. Diabetologia, 2005; 48:2460–2469.
24.
HainerTA. Managing older adults with diabetes. J Am Acad Nurse Pract, 2006; 18:309–317.
