Diabetes treatment and hypoglycaemic episodes in elderly patients at nursing homes in Uppsala County

Abstract

AimThe aim of this study was to examine the situation for elderly patients with diabetes living in nursing homes with regard to diabetes treatment, clinical variables, and vascular complications associated with diabetes. A second aim was to evaluate if the patients were at risk of hypoglycaemia.MethodsThis was a cross-sectional study including diabetes patients from all 30 nursing homes in Uppsala County, Sweden. Current antidiabetic medications, HbA1c, hypoglycaemic events, and diabetes complications were registered from the medical records. The patients were stratified into a general group and divided into three groups according to HbA1c (<52, 52–73, and >73 mmol/mol).ResultsOf 1,350 individuals, 218 patients were identified with diabetes mellitus. The diabetes duration was 11.2 ± 9.4 years and their serum HbA1c concentration 56.0 ± 1.2 mmol/mol. Hypoglycaemic events were reported in 24% of the diabetic individuals, and 43.1% of them had HbA1c <52 mmol/mol (mean value 44.0 ± 1.1 mmol/mol). Of these, 36% were taking antidiabetic drugs. Another 35.8% of the patients had HbA1c values between 52–73 mmol/mol (mean value 60.0 ± 1.1 mmol/mol), and 82% of these patients were taking antidiabetic drugs. Almost 80% of the diabetic patients had either micro- or macrovascular complications, with diabetes duration as an association for both micro- or macrovascular complications and hypoglycaemic events.ConclusionsA reduction of the use of antidiabetic drugs with follow-up of HbA1c level should be considered, especially for multimorbid elderly patients with low HbA1c and hypoglycaemia.

Educational Challenges to Nurses and Nurse Aides of Caring for Diabetic Patients at Home: A Systematic Review

“…8 Walfridsson et al who assessed the status of elderly diabetic patients in nursing homes for the care of the elderly and an article by the American Diabetes Association titled "Diabetes Management in Long-Term Care Nursing in Nursing Home" both shared common goals. 10,12 In the study of Walfridsson et al, the use of common antidiabetic drugs, HbA1c and blood glucose levels, and diabetes complications were documented in patient medical records. Blood glucose loss due to lack of nursing and medical stuff education was reported in 24% of diabetics, with only 43.1% of them having an HbA1c of less than 52 mm/L.…”

“…Blood glucose loss due to lack of nursing and medical stuff education was reported in 24% of diabetics, with only 43.1% of them having an HbA1c of less than 52 mm/L. 10 Of these patients, 36% consumed anti-diabetic drugs without instructional emphasis on the precise use of the drugs at a specified time and continuous prescription; 35.8% of the other patients had HbA1c values between 52-73 mg (mean = 60 ± 1.60 μm), and 82% of those were taking anti-diabetic drugs. Approximately 80% of diabetic patients without proper education had microvascular or macrovascular side effects, and the duration of diabetes was considered as a correlation between microvascular and macrovascular side effects and hypoglycemic events.…”

“…The findings of a systematic review on the challenges of education of caring for diabetic patients for nurses and nurse aides at home were analyzed. The studies had been published in several journals between 2012 and 2016 and included Yarnall et al, 6 Vajen et al, 7 Hausken and Graue, 3 Munshi et al, 8 American Diabetes Association, 9 Walfridsson et al, 10 and Haugstvedt et al 11 The publication date of the seven analytical studies showed that we are facing a relatively common and important issue in nursing research, i.e. the challenges of nursing home care provided by nurses and nurse aides ( Table 2).…”

“…In seven analytical studies, 1773 samples were studied. A cross-sectional study (Walfridsson et al 10 ) and a comparative study (Vajen et al 7 ) were also included. In this research, two issues were investigated: (1) Analysis of the challenges of care education for diabetic patients; (2) Abilities of nurses and nurse aides to care for patients with diabetes after receiving care education.…”

“…9 According to a study by Walfridsson et al, the use of antidiabetic drugs with follow-up on HbA1c levels, especially for elderly patients with low-grade HbA1c levels and often with symptoms of hypoglycemia, should be taken into account by the caregiver staff at home. 10 The study of Haugstvedt et al found that the Michigan Diabetes Knowledge Test addresses a wide range of topics related to diabetes care. This is an appropriate tool for identifying the individual and distinct needs of diabetes education among nursing staff.…”