Insulin treatment in diabetics 75+ years: experiences and results in outpatient care

Diabetes mellitus (DM) has a crucial impact on personal and social health. In the very old age it significantly affects also the social status of the individual. In the elderly 75+ y. DM occurs often in the domain of multi-morbidity and can conduce to incurrence and development of serious disability, which can significantly influence further therapeutic procedures. The study was aimed at analyzing the situation connected with the DM development, duration, insulin therapy period and overall approach in persons 75+ y. at 8 diabetological outpatient clinics of the Brno city. In the study we included 337 older diabetics 75+ y. who were long-term observed in the above mentioned diabetological outpatient clinics. There were 129 men and 208 women of the average age 79,3+/-4,9 y. (range 75-97 y.) out of this number. DM in patients of our set was detected in the age of 59,9+/-12,9 y. Its duration in the time of this study was 18,8+/-12,9 y. and the insulin therapy duration was 8,0+/-7,3 y. Good mobility was present in 303 persons (89,7%); 73 diabetics suffered from serious cognitive impairment - almost as to beginning dementia (22%). 159 seniors altogether had urinary incontinence, i.e. 47%. Within the study we analyzed such questions as: who applies insulin in the elderly; with whom he or she lives (24% of them are totally alone); how many times per day insulin is applied; which kind of insulin is used and whether there are hypoglycemias. We also took into consideration, if the senior owns a portable glucometer and who helps him or her with self-monitoring. Permanent insulin therapy represents in old age the kind of treatment which is very demanding for the old diabetic as well as for the nursing staff and the patient's close environment. A geriatric patient faces a long-term threat of decompensation of his/ her functional status and therefore he/she requires specific modification of the specialist's approach when deciding on the regimen and therapeutic measures.