Elderly diabetics at higher risk for insulin-related adverse events

Older adults with diabetes are more likely to experience insulin adverse event–related emergency department visits and hospitalizations, according to an analysis of nationally representative surveillance data presented at the American Diabetes Association annual meeting last month.

Compared with diabetes patients aged 45-64 years, those 80 years or older were 2.5 times more likely to present to the emergency department with an insulin adverse event (34.9 vs. 13.7/1,000 insulin-treated diabetes patients) and about five times more likely to be emergently hospitalized for such an event (16.1 vs. 3.3/1,000 persons), according to a report on the presentation by Internal Medicine News.

Andrew I. Geller, MD, of the Centers for Disease Control and Prevention who discussed the analysis at the ADA meeting, said that reducing insulin adverse events in older adults may have a significant public health impact. Insulin is the most commonly implicated medicine in U.S. emergency department visits, and is linked to about 14,000 hospitalizations annually among adults 65 years or older, IMN reported. Insulins and synthetic analogues also accounted for 71% of spending growth on antidiabetes medications in 2011, the trade publication said. Insulin adverse events led to an estimated 97,745 emergency department visits annually from 2007 to 2011, accounting for 6.5% of all adverse drug event–related ED visits, Geller said.

Patients aged 45-64 years had the highest proportion of emergency department visits (35%), followed by those 65-79 years (25.3%), 18-44 years (21.7%), 80 years or older (15.8%), and younger than 18 years (2.1%). But patients 80 years or older had a rate of 34.9 emergency department visits per 1,000 diabetic persons, far surpassing rates observed among those younger than 18 years (13.7), 18-44 years (24.3), 45-64 years (13.7), and 65-79 years (16.3). Patients aged 65-79 years had the highest proportion of hospitalizations (32.9%), but those 80 years and older had the highest rate of hospitalizations per 1,000 diabetic persons (16.1), compared with the other age groups: younger than 18 years (2.5), 18-44 years (3.9), 45-64 years (3.3), and 65-79 years (6.2).

Based on clinical and laboratory findings, about 65% of patients presented with shock, loss of consciousness, or seizure (23.2%); fall or other injury (5%); and altered mental status (37%), Dr. Geller said. More than half of patients had a blood glucose level less than 50 mg/dL.