Skip to main content
Journal of the Royal Society of Medicine logoLink to Journal of the Royal Society of Medicine
. 1994 Oct;87(10):612–614.

Tablet and insulin therapy in type 2 diabetes in the elderly.

A H Barnett 1
PMCID: PMC1294855  PMID: 7966113

Abstract

There are a range of therapeutic options available for the management of type 2 diabetes in the elderly. Diet remains the mainstay of treatment although this must be realistic. If diet alone is unsuccessful then, for most patients, short-acting sulphonylurea agents are the treatment of choice. Second line agents include the biguanide, metformin, or an alpha-glucosidase inhibitor. A significant proportion of type 2 diabetic patients will, however, eventually require insulin to alleviate symptoms of poor control and improve glycaemia. In this article I discuss the therapeutic options available for diabetic management in the elderly, with particular emphasis on the pros and cons of insulin treatment.

Full text

PDF
612

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asplund K., Wiholm B. E., Lithner F. Glibenclamide-associated hypoglycaemia: a report on 57 cases. Diabetologia. 1983 Jun;24(6):412–417. doi: 10.1007/BF00257338. [DOI] [PubMed] [Google Scholar]
  2. Berger W. Insulin therapy in the elderly type 2 diabetic patient. Diabetes Res Clin Pract. 1988;4 (Suppl 1):24–28. doi: 10.1016/0168-8227(88)90009-5. [DOI] [PubMed] [Google Scholar]
  3. Brinchmann-Hansen O., Dahl-Jørgensen K., Sandvik L., Hanssen K. F. Blood glucose concentrations and progression of diabetic retinopathy: the seven year results of the Oslo study. BMJ. 1992 Jan 4;304(6818):19–22. doi: 10.1136/bmj.304.6818.19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Campbell I. W. Metformin and the sulphonylureas: the comparative risk. Horm Metab Res Suppl. 1985;15:105–111. [PubMed] [Google Scholar]
  5. Elgrably F., Costagliola D., Chwalow A. J., Varenne P., Slama G., Tchobroutsky G. Initiation of insulin treatment after 70 years of age: patient status 2 years later. Diabet Med. 1991 Oct;8(8):773–777. doi: 10.1111/j.1464-5491.1991.tb01699.x. [DOI] [PubMed] [Google Scholar]
  6. Feinglos M. N., Lebovitz H. E. Sulphonylureas increase the number of insulin receptors. Nature. 1978 Nov 9;276(5684):184–185. doi: 10.1038/276184a0. [DOI] [PubMed] [Google Scholar]
  7. Gawler D., Milligan G., Houslay M. D. Treatment of streptozotocin-diabetic rats with metformin restores the ability of insulin to inhibit adenylate cyclase activity and demonstrates that insulin does not exert this action through the inhibitory guanine nucleotide regulatory protein Gi. Biochem J. 1988 Jan 15;249(2):537–542. doi: 10.1042/bj2490537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Genuth S. Insulin use in NIDDM. Diabetes Care. 1990 Dec;13(12):1240–1264. doi: 10.2337/diacare.13.12.1240. [DOI] [PubMed] [Google Scholar]
  9. Hosker J. P., Burnett M. A., Davies E. G., Harris E. A., Turner R. C. Sulphonylurea therapy doubles B-cell response to glucose in type 2 diabetic patients. Diabetologia. 1985 Nov;28(11):809–814. doi: 10.1007/BF00291069. [DOI] [PubMed] [Google Scholar]
  10. Peacock I., Tattersall R. B. The difficult choice of treatment for poorly controlled maturity onset diabetes: tablets or insulin? Br Med J (Clin Res Ed) 1984 Jun 30;288(6435):1956–1959. doi: 10.1136/bmj.288.6435.1956. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Prager R., Schernthaner G., Graf H. Effect of metformin on peripheral insulin sensitivity in non insulin dependent diabetes mellitus. Diabete Metab. 1986 Dec;12(6):346–350. [PubMed] [Google Scholar]
  12. Reichard P., Berglund B., Britz A., Cars I., Nilsson B. Y., Rosenqvist U. Intensified conventional insulin treatment retards the microvascular complications of insulin-dependent diabetes mellitus (IDDM): the Stockholm Diabetes Intervention Study (SDIS) after 5 years. J Intern Med. 1991 Aug;230(2):101–108. doi: 10.1111/j.1365-2796.1991.tb00415.x. [DOI] [PubMed] [Google Scholar]
  13. Ryder R. E. Lactic acidosis: high-dose or low-dose bicarbonate therapy? Diabetes Care. 1984 Jan-Feb;7(1):99–102. doi: 10.2337/diacare.7.1.99. [DOI] [PubMed] [Google Scholar]
  14. Tchobroutsky G. Relation of diabetic control to development of microvascular complications. Diabetologia. 1978 Sep;15(3):143–152. doi: 10.1007/BF00421230. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press

RESOURCES