Non-ICU Hospital Care of Diabetes Mellitus in the Elderly Population

The concept of lower is better when considering the goal for glycemic control in patients with diabetes mellitus has recently been challenged due to recent studies, such as ACCORD, ADVANCE, and VADT, which have observed increased morbidity and mortality from intensive control, especially in older adults, and in those with long duration of diabetes disease and chronic complications. Although evidence in younger patients suggest that blood glucose levels should not be above 180 mg/dl (10.0 mmol/l), there are many unanswered questions and controversies regarding the benefits and risks, methods to achieve and maintain these levels while avoiding hypoglycemia (<70 mg% (3.9 mmol/l)) in the older population. Since the population is aging with a greater life expectancy, it is crucial that these questions be answered. Although several studies of inpatient non-ICU diabetes management have been published, few include older patients. This review will examine available recommendations and explore those controversies regarding non-ICU hospital management in this vulnerable patient population. Additional conditions that impact upon achieving glycemic control will also be discussed. Finally, the older individual has many special needs which may be more important to consider than in young or middle-aged individuals, when transitioning care from in-hospital to home in a patient-centered approach, as recommended by the American Diabetes Association (ADA) and European Society for the Study of Diabetes (EASD).