Are elderly patients with diabetes being overtreated in French long-term-care homes?

Bouillet, Benjamin; Vaillant, G.; Petit, Jean‐Michel; Duclos, Marc; Poussier, A.; Brindisi, M.C.; Vergès, Bruno

doi:10.1016/j.diabet.2010.01.009

Cited by 49 publications

(19 citation statements)

References 8 publications

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“…The prevalence of diagnosed diabetes was reported to be 14%, comparable with other reports in Europe of 10-16% (10) (18) (19). A previous screening study found that over half of NH residents with diabetes are undiagnosed indicating that the true prevalence is higher (14).…”

Section: Discussionsupporting

confidence: 77%

Investigating the management of diabetes in nursing homes using a mixed methods approach

Hurley

O'Donnell

Ó’Caoimh

et al. 2017

Diabetes Research and Clinical Practice

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CitationInvestigating the management of diabetes in nursing homes using a mixed methods approach. STRUCTURED ABSTRACT AimsAs populations age there is an increased demand for nursing home (NH) care and a parallel increase in the prevalence of diabetes. Despite this, there is growing evidence that the management of diabetes in NHs is suboptimal. The reasons for this are complex and poorly understood. This study aimed to identify the current level of diabetes care in NHs using a mixed methods approach. MethodsThe nursing managers at all 44 NHs in County Galway in the West of Ireland were invited to participate. A mixed methods approach involved a postal survey, focus group and telephone interviews. ResultsThe survey response rate was 75% (33/44) and 27% (9/33) of nursing managers participated in the qualitative research. The reported prevalence of diagnosed diabetes was 14% with 80% of NHs treating residents with insulin. Hypoglycaemia was reported as 'frequent' in 19% of NHs. A total of 36% of NHs have staff who have received diabetes education or training and 56% have access to diabetes care guidelines. Staff education was the most cited opportunity for improving diabetes care. Focus group and interview findings highlight variations in the level of support provided by GPs and access to dietetic, podiatry and retinal screening services. ConclusionsThere is a need for national clinical guidelines and standards of care for diabetes management in nursing homes, improved access to quality diabetes education for NH staff, and greater integration between healthcare services and NHs to ensure equity, continuity and quality in diabetes care delivery HIGHLIGHTS The reported prevalence of diabetes in nursing homes in the West of Ireland is 14%  Only one third of nursing homes have staff with diabetes education or training  80% of nursing homes have residents that are managed with insulin  The level of medical support with insulin titration varies widely  Nursing home residents have limited access to ancillary diabetes services

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Section: Discussionsupporting

confidence: 77%

Investigating the management of diabetes in nursing homes using a mixed methods approach

Hurley

O'Donnell

Ó’Caoimh

et al. 2017

Diabetes Research and Clinical Practice

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“…A move toward more individualized HbA 1c targets in the elderly—specifically, more lenient targets in the frail elderly or those with limited life expectancy—has been mooted [33, 34], as treatment is placed in a risk–benefit context between good glycaemic control and the risk of hypoglycaemia [2, 20, 35, 36]. Current American Diabetes Association guidelines seem to reinforce this notion of loosening targets in the face of increasing risk, seen especially in the elderly [37].…”

Section: Discussionmentioning

confidence: 99%

Observational Study of Once-Daily Insulin Detemir in People with Type 2 Diabetes Aged 75 Years or Older

Karnieli¹,

Baeres

Dzida

et al. 2013

Drugs Aging

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ObjectivesOlder patients are particularly vulnerable to hypoglycaemia. The aim of this study was to evaluate the response to initiation of once-daily insulin detemir in patients aged ≥75 years with type 2 diabetes mellitus (T2DM) treated with one or more oral antidiabetic drugs (OADs).MethodsA sub-analysis was conducted using data from SOLVE (Study of Once daily LeVEmir), a 24-week observational study involving 3,219 investigators and 2,817 project sites from ten countries. Routine clinical practice was followed; there were no study-prescribed procedures. The total cohort comprised 17,374 participants, of whom 2,398 (14 %) were aged ≥75 years. The physicians collected information from patient recall, the patients’ medical records and their self-monitored blood glucose diaries (if kept).ResultsPre-insulin glycated haemoglobin (HbA1c) was similar between participants aged ≥75 years and those aged <75 years (HbA1c 8.8 ± 1.5 % vs. 8.9 ± 1.6 % [mean ± SD], respectively). After 24 weeks of treatment, similar reductions in HbA1c were observed in the two subgroups: 7.6 ± 1.1 % and 7.5 ± 1.2 % in participants aged ≥75 years and those aged <75 years, respectively. The incidence of severe hypoglycaemia (episodes per patient-year) decreased during the study in both age groups (from 0.057 to 0.007 in patients aged ≥75 years; from 0.042 to 0.005 in patients aged <75 years), while minor hypoglycaemia increased from 1.1 to 2.0 and from 1.7 to 1.8 episodes per patient-year in the older and younger age groups, respectively. Average weight reduction was similar in both groups: −0.5 kg (≥75 years) and −0.6 kg (<75 years).ConclusionIn both the older and younger age groups, the addition of once-daily insulin detemir to existing OAD regimens was effective and safe. In older patients, an improvement in HbA1c of 1.2 % was not associated with an increased risk of severe hypoglycaemia or weight gain.

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“…Already today, the prevalence of diabetes in nursing homes is particularly high and care for diabetes in this setting specific is often inappropriate or insufficient [25,26]. Moreover, diabetes in the elderly is a well-recognized cause of accelerated frailty, disability, hospitalization, institutionalization, and death, thus absorbing a growing fraction of healthcare resources [14,27,28].…”

Section: Methodsmentioning

confidence: 99%

Optimal therapy of type 2 diabetes: a controversial challenge

Dardano

Penno

Prato

et al. 2014

Aging

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Type 2 diabetes mellitus (T2DM) is one of the most common chronic disorders in older adults and the number of elderly diabetic subjects is growing worldwide. Nonetheless, the diagnosis of T2DM in elderly population is often missed or delayed until an acute metabolic emergency occurs. Accumulating evidence suggests that both aging and environmental factors contribute to the high prevalence of diabetes in the elderly. Clinical management of T2DM in elderly subjects presents unique challenges because of the multifaceted geriatric scenario. Diabetes significantly lowers the chances of “successful” aging, notably it increases functional limitations and impairs quality of life. In this regard, older diabetic patients have a high burden of comorbidities, diabetes-related complications, physical disability, cognitive impairment and malnutrition, and they are more susceptible to the complications of dysglycemia and polypharmacy. Several national and international organizations have delivered guidelines to implement optimal therapy in older diabetic patients based on individualized treatment goals. This means appreciation of the heterogeneity of the disease as generated by life expectancy, functional reserve, social support, as well as personal preference. This paper will review current treatments for achieving glycemic targets in elderly diabetic patients, and discuss the potential role of emerging treatments in this patient population.

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Are elderly patients with diabetes being overtreated in French long-term-care homes?

Cited by 49 publications

References 8 publications

Investigating the management of diabetes in nursing homes using a mixed methods approach

Investigating the management of diabetes in nursing homes using a mixed methods approach

Observational Study of Once-Daily Insulin Detemir in People with Type 2 Diabetes Aged 75 Years or Older

Optimal therapy of type 2 diabetes: a controversial challenge

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