Update on the management of diabetes in long-term care facilities

Abstract

The number of patients with diabetes is increasing among older adults in the USA, and it is expected to reach 26.7 million by 2050. In parallel, the percentage of older patients with diabetes in long-term care facilities (LTCFs) will also rise. Currently, the majority of LTCF residents are older adults and one-third of them have diabetes. Management of diabetes in LTCF is challenging due to multiple comorbidities and altered nutrition. Few randomized clinical trials have been conducted to determine optimal treatment for diabetes management in older adults in LTCF. The geriatric populations are at risk of hypoglycemia since the majority are treated with insulin and have different levels of functionality and nutritional needs. Effective approaches to avoid hypoglycemia should be implemented in these settings to improve outcome and reduce the economic burden. Newer medication classes might carry less risk of developing hypoglycemia along with the appropriate use of technology, such as the use of continuous glucose monitoring. Practical clinical guidelines for diabetes management including recommendations for prevention and treatment of hypoglycemia are needed to appropriately implement resources in the transition of care plans in this vulnerable population.

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

“…10 Dementia and cognitive impairment further put older adults with T2DM at higher risk of severe hypoglycemia due to their inability to identify or report hypoglycemia symptoms to caregivers. 21 In turn, caregivers may not recognize hypoglycemia in the population of older adults with T2DM, given the lack of adrenergic alarm symptoms, such as sweating, palpitations, and tremors. 12,21 Overall, given the high heterogeneity of the population of older adults with T2DM and the heterogeneity of the individual disease course, profiling patients is essential for better personalized management in order to avoid harm and maximize treatment benefits.…”

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review

“…Though a large body of published evidence exists on pharmacological agents and nonpharmacological interventions in regulating blood glucose concentration, the health systems' ability to support high-quality primary care in meeting patients' needs may be inadequate (2,(17)(18)(19)(20)(21). The essential management of non-communicable diseases (NCDs), particularly diabetes, has been postulated to depend largely on functioning health systems (22).…”

The prevalence and regional variability of diabetes among nursing home residents in Ontario

“…1,2 Due to frailty, multiple comorbidities, and functional and cognitive impairment, residents of nursing homes with DM have increased care needs and are at risk of both DM and treatment-related adverse events. 2,3 While the prevalence of DM in nursing homes in Ontario was previously reported at 25% in the early 2000s, DM rates in nursing homes may have increased given the overall increasing rates of DM in the general population. [4][5][6] This study examined the contemporary prevalence of DM among nursing home residents in Ontario, Canada, including regional variations in prevalence and resident characteristics.…”

“…The prevalence of diabetes mellitus (DM) increases with age and is a major contributor to morbidity and mortality 1,2 . Due to frailty, multiple comorbidities, and functional and cognitive impairment, residents of nursing homes with DM have increased care needs and are at risk of both DM and treatment‐related adverse events 2,3 .…”

“…The prevalence of diabetes mellitus (DM) increases with age and is a major contributor to morbidity and mortality 1,2 . Due to frailty, multiple comorbidities, and functional and cognitive impairment, residents of nursing homes with DM have increased care needs and are at risk of both DM and treatment‐related adverse events 2,3 . While the prevalence of DM in nursing homes in Ontario was previously reported at 25% in the early 2000s, DM rates in nursing homes may have increased given the overall increasing rates of DM in the general population 4–6 .…”