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Cover of Diabetic Diets for Frail Elderly Long-Term Care Residents with Type II Diabetes Mellitus: A Review of Guidelines

Diabetic Diets for Frail Elderly Long-Term Care Residents with Type II Diabetes Mellitus: A Review of Guidelines

Rapid Response Report: Summary with Critical Appraisal

People with type 2 diabetes, also known as non-insulin-dependent diabetes or adult onset diabetes, produce less insulin and are often overweight. The prevalence of type 2 diabetes increases with age as more people live longer. The prevalence of diabetes among Canadian seniors was 21.3% between 2006 and 2007. In the US, one in three residents of long-term care facilities have diabetes, of which 95% are type 2 diabetes. Older people with diabetes are at an increased risk for urinary tract infections, skin infections, foot ulcers, and pneumonia or flu. Treatment goals vary depending on the overall health of the residents. Usual goals for non-institutionalized adults include HbA1c <7.0%, before meal blood glucose levels 70–130 mg/dl, after meal (2 hours) blood glucose levels <180 mg/dl, blood pressure < 130/80 mmHg, and LDL cholesterol <100 mg/dl. Oral medications or injectable insulin are used to manage high blood sugar, while other agents may be used to control cardiovascular risk factors such as high blood pressure or cholesterol. However, good nutrition plays an important part of diabetes care, since undernutrition is common in frail older people, who often live in the long term care facilities and are dependent on the help of others to perform daily activities due to decreasing in strength, endurance and physiological function, the level of which can be characterized by using a clinical frailty scale. It is therefore important to know whether or not dietary restrictions such as “diabetic diets” should be used in such population. “Diabetic diets” are generally healthy diets that are individualized based on preferences, abilities and treatment goals using the advantages and disadvantages of dietary interventions listed in the chapter of Nutrition Therapy of the Canadian Diabetes Association Clinical Practice Guidelines.

The aim of this report is to review the guidelines regarding nutritional management for frail elderly residents in long term care.

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

Copyright © 2015 Canadian Agency for Drugs and Technologies in Health.

Copyright: This report contains CADTH copyright material. It may be copied and used for non-commercial purposes, provided that attribution is given to CADTH.

Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at

Bookshelf ID: NBK304586PMID: 26180888


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