Endocrine Abstracts

Introduction: Management of diabetes in older adults is complicated by the many comorbidities that may interfere with the use of certain oral antidiabetic agents, and the associated geriatric syndromes, psychiatric disorders, and high risk of dependence in this age group. The objective of our study was to determine the factors associated with poor diabetes control 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 2 months from June 2021 to July 2021.

Results: We recruited 100 patients with a mean age of 70.8±5.8 years and a sex ratio of 0.85. The mean durations of diabetes and insulin therapy were 15.67±6.7 years and 7.69±6 years, respectively. The mean level of HbA1C was 9.85±1.7%. The majority of patients had uncontrolled diabetes (90%). Poor diabetes control was associated with low socioeconomic level (77.8% vs 30%; P=0.001), uncontrolled high blood pressure (54.4% vs 20%; P=0.039), not removing insulin from refrigerator at least 30 minutes before use (82.2% vs 50%; P=0.018), not checking expiry dates of insulin and needles (75.6% vs 40%; P=0.018), using long needles (72.2% vs 30%; P=0.007), no hand washing before injection (34.4% vs 0%; P=0.025), no disinfecting the rubber of the insulin vial or pen cartridge (92.2% vs 70%; P=0.026), the incorrect re-suspension technique for cloudy insulin (no rolling or tipping the vial or cartridge of cloudy insulin: 91.1% vs 50%; P <10^-3 and 92.2% vs 60%; P=0.02, respectively), no rotating of the injection site (36.7% vs 0%; P=0.019), skiping the injections (51.7% vs 10%; P=0.012), bleeding or hematoma at the injection site (57.8% vs 20%; P=0.023) and the loss of insulin from the injection site (44.9% vs 10%; P=0.033). After multivariate analysis, no rolling and no tipping the vial or cartridge of cloudy insulin were factors independently associated with poor diabetes control (OR=12.599; 95% CI, 2.5 to 63.35; P=0.002 and OR=10.188; 95% CI, 1.825 to 56.875; P=0.008, respectively).

Conclusion: The challenge to overcome in optimizing diabetes management is not a lack of recommendations or scales. However, it is their adoption and implementation by caregivers and patients that dismisses the need for optimal insulin injection technique as a fundamental driver of diabetes control that could turn the game around.