Nursing home patients with diabetes: Prevalence, drug treatment and glycemic control

Andreassen, Lillan Mo; Sandberg, Sverre; Kristensen, Gunn B.B.; Sølvik, Una Ørvim; Kjome, Reidun Lisbet Skeide

doi:10.1016/j.diabres.2014.04.012

Cited by 51 publications

(58 citation statements)

References 39 publications

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“…sjukeheim er litt lågare enn kva som har blitt vist i tidlegare studiar (2)(3)(4)29). Ei årsak kan vera at det ikkje er gode nok rutinar for diagnostisering og at fleire bebuarar kan ha diabetes utan at ein er klar over det.…”

Section: Diskusjonunclassified

Dokumentasjon og oppfølging av bebuarar med diabetes i sjukeheim

Heimro¹,

Haugstvedt²

2015

Sykepleien

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Background:The healthcare system in Norway has a goal of basing services on research-based knowledge. Studies indicate that recommended and clinical practice frequently deviate. Little is known about the quality of follow-up of people with diabetes in nursing homes in Norway, but international studies show a great variation in the quality of diabetes care for residents of institutions.Objective: The purpose of this study was to determine whether the procedures for monitoring glycaemic control among nursing-home residents with diabetes in Norway were in accordance with the recommendations of evidence-based guidelines. Methods:We reviewed the electronic records of all residents with diabetes at three nursing homes in Bergen using clinical audit as the method. We analyzed the findings and considered them based on the recommendations of researchbased guidelines.Results: Fifty residents (14 %) met the requirements for participating. Of these, two (4 %) had individual goals for HbA1c documented in their medical records, nine residents (18 %) had individual procedures for measuring blood glucose and 16 residents (37 %) had HbA1c measured at least once in six months as recommended by research-based guidelines. Conclusion:The audit showed a discrepancy between current practice and recommendations of research-based guidelines regarding monitoring of blood glucose among the residents with diabetes at three nursing homes. This may indicate a need to improve the quality of diabetes follow-up by nursing homes in Norway.

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Section: Diskusjonunclassified

Dokumentasjon og oppfølging av bebuarar med diabetes i sjukeheim

Heimro¹,

Haugstvedt²

2015

Sykepleien

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“…Nursing home residents with DM are more likely to be admitted to hospitals and visit emergency departments . They more often have hypoglycemia, which is known to be associated with dementia, falls, fractures, cardiovascular diseases and death …”

Section: Introductionmentioning

confidence: 99%

Low hemoglobin A1c and low body mass index are associated with dementia and activities of daily living disability among Japanese nursing home residents with diabetes

Hatano

Araki

Ishibashi

2019

Geriatrics Gerontology Int

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Aim: To investigate associations between glycemic control and dementia, activities of daily living (ADL), falls and fractures in Japanese older adults with type 2 diabetes mellitus living in nursing homes.Methods: A total of 384 older residents with diabetes aged ≥65 years from 95 out of 132 facilities in Hiroshima Prefecture were studied in a cross-sectional study in 2016. Primary outcomes were differences in severity of dementia and ADL among three glycosylated hemoglobin level groups. Secondary end-points included differences in falls, fragility fracture and severe hypoglycemia.Results: Approximately 67.6% of patients receiving any diabetes treatment received dipeptidyl peptidase-4 inhibitors, and 26.0% received sulfonylureas. Patients with glycosylated hemoglobin <7.0% had a significantly higher severity of dementia compared with those with glycosylated hemoglobin 7.0-7.9% (beta AE SE, 0.55 AE 0.26; 95% CI 0.04-1.06) in multivariable ordinal logistic regression analysis. This tendency was observed particularly in patients using insulin (1.91 AE 0.91; 95% CI 0.13-3.69) or both sulfonylureas and dipeptidyl peptidase 4 (2.14 AE 0.88; 95% CI 0.41-3.87). Low body mass index was significantly associated with dementia (−0.08 AE 0.03; 95% CI −0.14 -−0.03) and ADL impairment (−0.15 AE 0.03; 95% CI −0.20 -−0.09), and fractures (odds ratio OR 0.89 per kg/m 2 ; 95% CI 0.84-0.96).Conclusions: Tight glycemic control was related to dementia in residents treated with insulin and sulfonylureas, and low body mass index was associated with dementia, ADL disability and fractures. Optimization of glycemic control and weight for people with diabetes in longterm care facilities could be important for the maintenance of cognitive and physical function.

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“…They have a disproportionately high number of clinical complications and comorbidities that can increase hypoglycemia risk: impaired cognitive and renal function, slowed hormonal regulation and counterregulation, suboptimal hydration, variable appetite and nutritional intake, polypharmacy, and slowed intestinal absorption (42). Emerging studies suggest that insulin and noninsulin agents confer similar glycemic outcomes and rates of hypoglycemia in LTC populations (30,43). Another consideration for the LTC setting is that unlike the hospital setting, medical providers are not required to evaluate the patients daily.…”

Section: Hypoglycemiamentioning

confidence: 99%

“…6.1) and periodically adjusted based on coexisting chronic illnesses, cognitive function, and functional status (2). Tighter glycemic control in older adults with multiple medical conditions is associated with an increased risk of hypoglycemia and considered overtreatment but, unfortunately, is common in clinical practice (30)(31)(32). When patients are found to have an insulin regimen with complexity beyond their self-management abilities, deintensification (or simplification) can reduce hypoglycemia and disease-related distress without worsening glycemic control (33,34).…”

Section: Beyond Glycemic Controlmentioning

confidence: 99%

11. Older Adults:Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

128

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Nursing home patients with diabetes: Prevalence, drug treatment and glycemic control

Cited by 51 publications

References 39 publications

Dokumentasjon og oppfølging av bebuarar med diabetes i sjukeheim

Dokumentasjon og oppfølging av bebuarar med diabetes i sjukeheim

Low hemoglobin A1c and low body mass index are associated with dementia and activities of daily living disability among Japanese nursing home residents with diabetes

11. Older Adults:Standards of Medical Care in Diabetes—2018

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