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AMDA Clinical Practice Guidelines for Treating Type 2 Diabetes in Long-Term Care (LTC) Residents

Caution should be exercised when administering insulin to elderly patients. In elderly patients with diabetes, dosing should be conservative to avoid hypoglycemia. Hypoglycemia is the most common adverse effect of insulin, including Lantus®. Hypoglycemia may be difficult to recognize in the elderly.

A tailored approach is recommended

  • AGS recommendations for A1C goals are based on life expectancy, frailty, presence of comorbidities, cognitive impairment, and functional disability5
  • In many cases, a resident's disease has progressed beyond control with 1 or more oral medications1
  • Care is required in prescribing and monitoring treatment regimens. Oral agents may be contraindicated in patients with certain comorbidities4
  • According to the AMDA standards of care, glycemic goals should be tailored according to the patient's risk of hypoglycemia4
  • Glycemic goals for older adults who are not functional, not cognitively intact, or who do not have significant life expectancy may be relaxed using individual criteria. However, hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided in all patients if possible

Consider less stringent glycemic goals for frail older residents or those with the following conditions1:

  • Are dependent on others for feeding or generally have a poor prognosis
  • Have anorexia, gangrene, malignancy, or severe dementia
  • Have hypoglycemia unawareness or recurrent idiopathic hypoglycemic episodes
  • Have a life expectancy of less than 5 years

As type 2 diabetes progresses, many LTC residents will require insulin to manage their disease.

Basal prandial regimen vs SSI Monotherapy

A basal-prandial regimen significantly reduced BG vs SSI monotherapy in the RABBIT 2 Study.

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  1. Holman RR. Diab Res Clin Pract.1998;40(suppl):S21-S25.
  2. DeFronzo RA. Diabetes. 2009;58:773-795.
  3. Hirsch IB, Bergenstal RM, Parkin CG, Wright E, Buse JB. Clin Diabetes. 2005;23(2):78-86.
  4. American Medical Directors Association. Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA 2008, revised 2010.
  5. Migdal A, Yarandi SS, Smiley D, Umpierrez GE. J Am Med Dir Assoc. 2011;12:627-632.
  6. Pandya N, Nathanson E. J Am Med Dir Assoc. 2010;11:171-178.
  7. American Diabetes Association. Diabetes Care. 2011;34(suppl 1): S11-S61.
  8. Brown AF, Mangione CM, Saliba D, Sarkisian CA; California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Older Persons with Diabetes. J Am Geriatr Soc. 2003;51(5 suppl): S265-S280.
  9. American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(suppl 2):1-53.

Proven HbA1c control

See how Lantus® provides effective, improved glycemic control in diabetes patients.

Lantus® Prescribing Information. February 2015.

Once-daily dosing

Lantus® is a once-daily, long-acting insulin.**

**Lantus® Prescribing Information. February 2015.

Demonstrated long-term CV safety

Lantus® is a basal insulin with demonstrated long-term CV safety data††

††Including CV death, nonfatal MI, nonfatal stroke, revascularization, or hospitalization for heart failure. No difference was observed between Lantus® and standard of care in overall incidence of CV death, nonfatal MI, or nonfatal stroke. No difference was observed between treatment groups for death of any cause.