Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Am Med Dir Assoc. 2013 Nov;14(11):842-6. doi: 10.1016/j.jamda.2013.08.001. Epub 2013 Sep 20.

Prevalence, quality of care, and complications in long term care residents with diabetes: a multicenter observational study.

Author information

  • 1Department of Medicine, Emory University, Atlanta, GA.

Abstract

BACKGROUND:

Few studies have reported on the quality of diabetes care and glycemic control adjusted for medication use in long term care (LTC) facilities.

METHODS:

This observational study analyzed diabetes prevalence and management and the impact of glycemic control on clinical outcome in elderly subjects admitted to 3 community LTC facilities.

RESULTS:

Among 1409 LTC residents (age 79.7 ± 12 years), the prevalence of diabetes was 34.2%. Subjects with diabetes were either on no pharmacological agents (10%) or were treated with sliding scale regular insulin (SSI, 25%), oral antidiabetic drugs (OAD, 5%), insulin (34%), or with combination of OAD and insulin (26%). Patients with diabetes had a mean daily BG of 156 ± 39 mg/dL and a mean admission HbA1c of 6.7% ± 1.1%. Compared with nondiabetes, residents with diabetes had higher number of complications (54% vs 45%, P < .001), infections (26% vs 21%, P = .036), emergency room (ER) and hospital transfers (37% vs 30%, P = .003), but similar mortality (15% vs 14%, P = .56). A total of 43% of residents with diabetes had a BG less than 70 mg/dL, and those with hypoglycemia had longer median length of stay (LOS, 52 vs 29 days, P < .001), more ER or hospital transfers (56% vs 69%, P = .005), and mortality (20% vs 10%, P = .002) compared with residents without hypoglycemia.

CONCLUSION:

Diabetes is common in LTC residents and is associated with higher resource utilization and complications. Hypoglycemia is common and is associated with increased need of emergency room visits and hospitalization and higher mortality. Our findings emphasize the need for randomized trials evaluating the impact of different approaches to glycemic management on clinical outcome in LTC residents with diabetes.

Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.

KEYWORDS:

Nursing home; basal insulin; hospital hyperglycemia; inpatient hyperglycemia; long term care; sliding scale insulin

PMID:
24055534
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk