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Management of Inpatient Hyperglycemia and Diabetes in Older Adults
Adults aged 65 years and older are the fastest growing segment of the U.S. population, and their number is expected to double to 89 million between 2010 and 2050. The prevalence of diabetes in hospitalized adults aged 65–75 years and over 80 years of age has been estimated to be 20% and 40%, respect...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Diabetes Association
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864102/ https://www.ncbi.nlm.nih.gov/pubmed/28325798 http://dx.doi.org/10.2337/dc16-0989 |
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author | Umpierrez, Guillermo E. Pasquel, Francisco J. |
author_facet | Umpierrez, Guillermo E. Pasquel, Francisco J. |
author_sort | Umpierrez, Guillermo E. |
collection | PubMed |
description | Adults aged 65 years and older are the fastest growing segment of the U.S. population, and their number is expected to double to 89 million between 2010 and 2050. The prevalence of diabetes in hospitalized adults aged 65–75 years and over 80 years of age has been estimated to be 20% and 40%, respectively. Similar to general populations, the presence of hyperglycemia and diabetes in elderly patients is associated with increased risk of hospital complications, longer length of stay, and increased mortality compared with subjects with normoglycemia. Clinical guidelines recommend target blood glucose between 140 and 180 mg/dL (7.8 and 10 mmol/L) for most patients in the intensive care unit (ICU). A similar blood glucose target is recommended for patients in non-ICU settings; however, glycemic targets should be individualized in older adults on the basis of a patient’s clinical status, risk of hypoglycemia, and presence of diabetes complications. Insulin is the preferred agent to manage hyperglycemia and diabetes in the hospital. Continuous insulin infusion in the ICU and rational use of basal-bolus or basal plus supplement regimens in non-ICU settings are effective in achieving glycemic goals. Noninsulin regimens with the use of dipeptidyl peptidase 4 inhibitors alone or in combination with basal insulin have been shown to be safe and effective and may represent an alternative to basal-bolus regimens in elderly patients. Smooth transition of care to the outpatient setting is facilitated by providing oral and written instructions regarding timing and dosing of insulin as well as education in basic skills for home management. |
format | Online Article Text |
id | pubmed-5864102 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | American Diabetes Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-58641022018-04-01 Management of Inpatient Hyperglycemia and Diabetes in Older Adults Umpierrez, Guillermo E. Pasquel, Francisco J. Diabetes Care Emerging Science and Concepts for Management of Diabetes and Aging Adults aged 65 years and older are the fastest growing segment of the U.S. population, and their number is expected to double to 89 million between 2010 and 2050. The prevalence of diabetes in hospitalized adults aged 65–75 years and over 80 years of age has been estimated to be 20% and 40%, respectively. Similar to general populations, the presence of hyperglycemia and diabetes in elderly patients is associated with increased risk of hospital complications, longer length of stay, and increased mortality compared with subjects with normoglycemia. Clinical guidelines recommend target blood glucose between 140 and 180 mg/dL (7.8 and 10 mmol/L) for most patients in the intensive care unit (ICU). A similar blood glucose target is recommended for patients in non-ICU settings; however, glycemic targets should be individualized in older adults on the basis of a patient’s clinical status, risk of hypoglycemia, and presence of diabetes complications. Insulin is the preferred agent to manage hyperglycemia and diabetes in the hospital. Continuous insulin infusion in the ICU and rational use of basal-bolus or basal plus supplement regimens in non-ICU settings are effective in achieving glycemic goals. Noninsulin regimens with the use of dipeptidyl peptidase 4 inhibitors alone or in combination with basal insulin have been shown to be safe and effective and may represent an alternative to basal-bolus regimens in elderly patients. Smooth transition of care to the outpatient setting is facilitated by providing oral and written instructions regarding timing and dosing of insulin as well as education in basic skills for home management. American Diabetes Association 2017-04 2017-03-10 /pmc/articles/PMC5864102/ /pubmed/28325798 http://dx.doi.org/10.2337/dc16-0989 Text en © 2017 by the American Diabetes Association. http://www.diabetesjournals.org/content/licenseReaders may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license. |
spellingShingle | Emerging Science and Concepts for Management of Diabetes and Aging Umpierrez, Guillermo E. Pasquel, Francisco J. Management of Inpatient Hyperglycemia and Diabetes in Older Adults |
title | Management of Inpatient Hyperglycemia and Diabetes in Older Adults |
title_full | Management of Inpatient Hyperglycemia and Diabetes in Older Adults |
title_fullStr | Management of Inpatient Hyperglycemia and Diabetes in Older Adults |
title_full_unstemmed | Management of Inpatient Hyperglycemia and Diabetes in Older Adults |
title_short | Management of Inpatient Hyperglycemia and Diabetes in Older Adults |
title_sort | management of inpatient hyperglycemia and diabetes in older adults |
topic | Emerging Science and Concepts for Management of Diabetes and Aging |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864102/ https://www.ncbi.nlm.nih.gov/pubmed/28325798 http://dx.doi.org/10.2337/dc16-0989 |
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