Endocrine Abstracts

Introduction: Type 2 diabetes, which accounts for more than 90% of all diabetes in the elderly, is a major public health problem. It is associated with high morbidity and mortality, mainly due to complications such as cardiovascular events and renal failure. The objective of our study was to determine the characteristics of type 2 diabetes in insulin-requiring elderly subjects.

Methods: A cross-sectional study on type 2 diabetic insulin dependent elderly recruited from the outpatient endocrinology consultation over a period of 7 months from April 2021 to October 2021.

Results: A total of 282 patients were included in our study with a mean age of 72.33±6.35 years and a sex ratio of 0.9. In association with diabetes, hypertension was the most common chronic disease (71.3%) followed by dyslipidemia (58.9%). The mean duration of diabetes and insulin therapy was 15.89±7 and 7.85±5.5 years, respectively. Only one third of patients were on insulin analogue. The basal double injection regimen was the most prescribed in our population (22.7%). Regular follow-up and self-monitoring of blood glucose were noted in 68.1% and 55% of patients, respectively. Nocturia, hypoglycaemic malaise, unrecognized hypoglycaemia, and severe hypoglycaemia were reported by 59.2%, 69.1%, 23.8%, and 30.5% of patients, respectively. The mean HbA1C level was 9.72%±1.81%. Only 17% of our patients had controlled diabetes. Less than a third of the patients (29.8%) had a history of hospitalization for diabetes decompensation, mainly for chronic diabetes imbalance (70.2%). Degenerative complications of diabetes were dominated by microangiopathic complications (83.7%). Diabetic neuropathy accounted for 72% followed by diabetic retinopathy in 57.4% of cases and diabetic nephropathy (17%). Macroangiopathic complications were noted in 45% of cases: the most frequent was arteriopathy obliterating of the lower extremities (27%) followed by myocardial infarction in 23.8% and stroke (12.8%). The diabetic foot was found in 8.5% of patients.

Conclusion: Despite unprecedented advances in insulin therapy and injection means, controlling diabetes in the elderly remains a challenge. Indeed, initiation of insulin therapy in older diabetic patients requires a complete geriatric assessment to identify factors that may complicate diabetes control.