This article is the fourth in a continuing series on diabetes in the elderly. The third article in the series,“Diabetes Agents in the Elderly: An Update of New Therapies and a Review of Established Treatments,” was published in the June issue of the Journal. The remaining articles in the series will discuss such topics as the role of exercise and dietary supplements in the management of diabetes, and microvascular and macrovascular complications of diabetes.

According to the Third National Health And Nutrition Examination Survey (NHANES III), approximately 20% of the US population develops diabetes by the age of 75, 1 and at least half of these patients are unaware that they have the disease. 2 Both insulin resistance and relative insulin deficiency characterize type 2 diabetes. Therapy should entail diet, weight reduction, and exercise. Patients with persistent hyperglycemia are often started on one or more oral hypoglycemic drugs. Many patients with type 2 diabetes will require insulin as their beta cell function declines over time. Insulin is usually started when full doses of oral hypoglycemic agents are not achieving acceptable glycemic control. The clinician’s options have increased with new insulin analogues that physiologically attempt to match the insulin peaks of the normal glycemic state, enabling patients to achieve tighter glycemic control in a potentially safer way. In this article, we discuss the role of human insulin and new insulin analogues in managing diabetes in the elderly population.