How well are we managing diabetes in long-term care?

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Original Research

How well are we managing diabetes in long-term care?

J Fam Pract. 2012 August;61(8):467-472

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References

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One hundred ten (44.9%) of the 245 patients in our study were prescribed a statin. Various studies support the use of lipid-lowering medications to increase HDL in elderly patients with DM.⁸ Yet data suggest that the rate of statin use among older adults is suboptimal.¹⁹ Our study highlights the limited prescription of statins for elderly nursing home patients who need them.

The ADA lipid goals are reasonable for this patient population, especially considering the potential mortality benefit. Rather than adjust lipid and BP goals, standards of care should emphasize the importance of meeting these objectives and suggest means to achieve them, including greater use of statins.

FAST TRACK

A strict approach to A1c levels does not work for elderly, frail patients because the risk of hypoglycemic episodes is too great.

One set of standards does not work for all patients. Our study demonstrates that the ADA standards of care for ambulatory adults with diabetes are not acceptable for long-term care residents with DM. Although stringent A1c goals are appropriate for ambulatory adults, the risk of hypoglycemic episodes among the older and frailer nursing home population is too great to adhere to such a strict approach.

We recommend new guidelines be established. Guidelines developed specifically for residents in extended care are necessary to ensure the proper care of these patients, particularly in the face of a steady increase in their number.

Study limitations. Future inquiries into this subject should take into account the weaknesses of this study. First, it was conducted solely in Ohio and West Virginia. A chart review covering more territory could explore regional differences in diabetes care provided by long-term facilities and provide more evidence of the need for a population-specific standards of care.

The study also failed to account for comorbid conditions, including dementia, and code status, and followed residents for only one year. More extensive reviews could examine the effects of therapy in this patient population and the relationship between mortality and treatment plan, spurring movement toward more uniform and effective care of patients with diabetes in the long-term care setting.

CORRESPONDENCE Jay Shubrook Jr, DO, Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Grosvenor Hall, Athens, OH 45701; shubrook@ohio.edu