Introducing insulin into diabetes management: transition strategies for older adults.

Many older adults with type 2 diabetes require insulin to supplement or replace oral hypoglycemic control. Overtime, the addition of this more intensive therapy is needed to preserve beta cell function or prevent macrovascular sequelae. This is the result of the natural progression of diabetes and not a failure on the part of the patient. Clinicians must evaluate many factors in an attempt to individualize a safe optimal glycemic level for older adults. Considerations should include when insulin should be initiated, the type of insulin and regimen, and a safe individualized target goal while preventing hypoglycemia. Important in this decision are the patients comorbid condition, functional and cognitive status, social environment, financial ability, and life expectancy. The risks and benefits of more stringent glycemic control must be considered in the context of treatment options, priorities, and quality-of-life issues for both the patient and family.