Optimizing Insulin Use in Type 2 Diabetes: Role of Basal and Prandial Insulin in Long-Term Care Facilities

Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study

“…Data from several studies suggest that a significant proportion of elderly LTC facility residents receive suboptimal diabetes care, 1 despite the identification of numerous opportunities for improving care quality among nursing home residents with diabetes. 9 For example, the development of treatment algorithms, together with the implementation of quality improvement tools that follow appropriate process and outcome indicators have been proposed as a means of improving the management of diabetes in this setting.…”

“…Diabetes is a common condition in the long-term care (LTC) setting, where approximately 25% of LTC facility residents in the US are affected. 1 Diabetes management in this setting is complicated because, compared with individuals without diabetes, diabetes is often associated with increased rates of premature mortality, functional disability, cognitive dysfunction, and comorbidities (eg, hypertension, stroke, coronary heart disease, depression, dementia) in elderly patients. 2 , 3 Factors such as renal insufficiency, coexisting illnesses, polypharmacy, irregular meal patterns, and cognitive and functional impairment can lead to an increased risk of hypoglycemia in the elderly; 4 therefore, optimizing the treatment of diabetes is a vital component of the care required in LTC facilities.…”

“… 2 , 3 Factors such as renal insufficiency, coexisting illnesses, polypharmacy, irregular meal patterns, and cognitive and functional impairment can lead to an increased risk of hypoglycemia in the elderly; 4 therefore, optimizing the treatment of diabetes is a vital component of the care required in LTC facilities. 1 , 5…”

“… 6 In patients with type 2 diabetes mellitus (T2DM), adding a long-acting insulin analog to an oral antidiabetic drug (OAD) is a simple, safe, and effective strategy for introducing insulin therapy when OADs are no longer adequate to control hyperglycemia. 1 …”

Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care: A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility

“…23 Nevertheless, SSI use persists in LTC and US hospitals despite a lack of evidence of its superiority after decades of use; the call to optimize insulin use in LTC is not new. 24…”