Diabetes is highly prevalent in the elderly, afflicting about 20% of older adults aged 65-75
years and 40% of adults >80years of age. It is expected that the number of elderly people
suffering from diabetes will increase in the future, as general life expectancy is
increasing.
Nursing home residents with diabetes have higher rates of serious comorbidities and have
greater activity of daily living dependencies than other residents without diabetes. In
addition, persons with diabetes have higher risk of hypertension, heart disease, stroke
depression, cognitive impairment, and cardiovascular mortality than individuals without
diabetes.
There are a few retrospective studies in elderly patients analyzing quality of diabetes care
and glycemic control adjusted for medications and presence of co-morbidities in long-term
care facilities; however, no previous randomized controlled trials have demonstrated benefits
of glycemic control on clinical outcome, quality of life, and rate of acute metabolic
complications (hyperglycemia and hypoglycemic events) in long-term care facilities. In
addition, it is not known whether the use of basal insulin is superior to treatment with
sliding scale insulin (SSI) in long-term care facility residents with type 2 diabetes.
Accordingly, the investigators propose to conduct a prospective randomized control trial
comparing the efficacy and safety of the basal (glargine) insulin regimen and sliding scale
regular insulin in the management of nursing home patients with T2DM.