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Cited by 44Diabetes Treatment and ManagementHyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and Research

A randomized controlled trial comparing treatment with oral agents and basal insulin in elderly patients with type 2 diabetes in long-term care facilities

Open access
Pasquel, Francisco J, Powell, Winter, Peng, Limin, Johnson, Theodore M, Sadeghi-Yarandi, Shadi, Newton, Christopher, Smiley, Dawn, Toyoshima, Marcos T +2 more·2015·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2015-000104PMC PMC4553905
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Abstract

BACKGROUND: Managing hyperglycemia and diabetes is challenging in geriatric patients admitted to long-term care (LTC) facilities. METHODS: This randomized control trial enrolled patients with type 2 diabetes (T2D) with blood glucose (BG) >180 mg/dL or glycated hemoglobin >7.5% to receive low-dose basal insulin (glargine, starting dose 0.1 U/kg/day) or oral antidiabetic drug (OAD) therapy as per primary care provider discretion for 26 weeks. Both groups received supplemental rapid-acting insulin before meals for BG >200 mg/dL. Primary end point was difference in glycemic control as measured by fasting and mean daily glucose concentration between groups. RESULTS: A total of 150 patients (age: 79±8 years, body mass index: 30.1±6.5 kg/m(2), duration of diabetes mellitus: 8.2±5.1 years, randomization BG: 194±97 mg/dL) were randomized to basal insulin (n=75) and OAD therapy (n=75). There were no differences in the mean fasting BG (131±27 mg/dL vs 123±23 mg/dL, p=0.06) between insulin and OAD groups, but patients treated with insulin had greater mean daily BG (163±39 mg/dL vs 138±27 mg/dL, p<0.001) compared to those treated with OADs. There were no differences in the rate of hypoglycemia (<70 mg/dL) between insulin (27%) and OAD (31%) groups, p=0.58. In addition, there were no differences in the number of hospital complications, emergency room visits, and mortality between treatment groups. CONCLUSIONS: The results of this randomized study indicate that elderly patients with T2D in LTC facilities exhibited similar glycemic control, hypoglycemic events and complications when treated with either basal insulin or with oral antidiabetic drugs. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01131052.

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  • Oral agents may achieve glycemic outcomes similar to basal insulin in LTC populations.

    “Oral agents may achieve glycemic outcomes similar to basal insulin in LTC populations (93,129).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [129]

  • Oral agents may achieve glycemic outcomes similar to basal insulin in PALTC populations.

    “Oral agents may achieve glycemic outcomes similar to basal insulin in PALTC populations (100,148).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [148]

  • Oral agents may achieve glycemic outcomes similar to those for basal insulin in PALTC residents with type 2 diabetes.

    “Oral agents may achieve glycemic outcomes similar to those for basal insulin in PALTC residents with type 2 diabetes (109,167).”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [167]

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Cited by

Sorted by citations

Authors
Pasquel, F. J., Powell, W., Peng, L., Johnson, T. M., Sadeghi-Yarandi, S., Newton, C., Smiley, D., Toyoshima, M. T., Aram, P., & Umpierrez, G. E.
Affiliations
Emory University (US)
Corresponding author
Umpierrez, Guillermo E
ORCID
Venue
BMJ Open Diabetes Research & Care
Publisher
BMJ
Published
2015-08
Volume
3
Issue
1
Pages
e000104
ISSN
2052-4897 (ISSN-L)
DOI
10.1136/bmjdrc-2015-000104
PMC
PMC4553905
OpenAlex
W2147623897
Cited by
44
References
5
Citations by year
2026: 2 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 1
FWCI
2.90
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • American Diabetes Association (1-14-LLY-36)
  • Sanofi
  • Emory University (RR025008)
  • Regeneron Pharmaceuticals
  • Novo Nordisk
  • National Center for Research Resources (UL1RR025008, M01RR000039)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 2 diabetes, elderly patients, long-term care facilities, basal insulin, glargine, oral antidiabetic drugs, glycemic control, hypoglycemia, hyperglycemia, rapid-acting insulin, geriatric diabetes management

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