Diabetes in a geriatric ward: efficacy and safety of new insulin analogs in very old inpatients

We analysed the medical records of 1851 elderly inpatients admitted to our geriatric clinic from March 2009 to September 2011, to identify patients with DM. The efficacy and safety of insulin analogs were measured in patients with a hospital stay of at least 9 days, by assessing the means of all glycemic sticks (4-7 sticks/day), number of hyperglycemic events (>250 mg/dL) and number of hypoglycemic events (<70 mg/dL) daily. DM prevalence was 25% (463/1851). Diabetic patients' mean age was 82.9 7.5 years. DM mortality during hospital stay was 10.8% vs 6.7% for non-diabetics (p<0.05). 206/463 diabetic inpatients were treated with insulin, and 85.9% of them received analogs (Rapid and Longer-Acting). Decreases in mean daily glycemia values (from 218.8 81.6 mg/dL to 170.9 42.9 mg/dL, p<0.001) and in number of hyperglycemic events (from 118 to 47) (p<0.012) were noted in 128 insulin analog-treated patients over the 9-day hospitalization. Only 35 hypoglycemic events were found out of 4745 sticks (0.7%). 1) DM prevalence and mortality in our very old inpatients are high and similar to data reported in the literature. 2) Insulin therapy with analogs is effective (achieves good glycemic control) and safe (low rate of hypoglycemia) even in these frail, very old inpatients.