11.0.0.0 Prev. Admissions & Readmissions
11.1.0.0 Preventing Hypoglycemic Admissions in Older Adults
Insulin-treated patients 80 years of age or older are more than twice as likely to visit the emergency department and nearly five times as likely to be admitted for insulin-related hypoglycemia than those 45–64 years of age (83). However, older adults with type 2 diabetes in long-term care facilities taking either oral antihyperglycemic agents or basal insulin have similar glycemic control (84), suggesting that oral therapy may be used in place of insulin to lower the risk of hypoglycemia for some patients. In addition, many older adults with diabetes are overtreated (85), with half of those maintaining an A1C <7% (53 mmol/mol) being treated with insulin or a sulfonylurea, which are associated with hypoglycemia. To further lower the risk of hypoglycemia-related admissions in older adults, providers may, on an individual basis, relax A1C targets to 8% (64 mmol/mol) or 8.5% (69 mmol/mol) in patients with shortened life expectancies and significant comorbidities (refer to Section 12 “Older Adults” for detailed criteria).