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Bhalla H, Huang G, Seaman K, Silva SSM, Wu B, Wabe N, Westbrook JI, Nguyen AD. Diabetes in residential aged care: Pharmacological management and concordance with clinical guidelines. Australas J Ageing 2024. [PMID: 38961713 DOI: 10.1111/ajag.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Existing studies have highlighted suboptimal diabetes management in residential aged care facilities (RACFs). However, understanding of diabetes management in Australian metropolitan RACFs has been limited. This retrospective cohort study aimed to explore the pharmacological management of diabetes in 25 RACFs in Sydney Australia and assess concordance with clinical practice guidelines (CPGs). METHODS Data from 231 permanent RACF residents aged ≥65 years and over with type 2 diabetes mellitus over the period from 1 July 2016 to 31 December 2019 were used. Concordance was measured by assessing the medications and medical history data for each individual resident for concordance with evidence-based CPGs. Multivariable logistic regression was used to estimate the effect of resident characteristics on concordance with CPGs. RESULTS Of the 231 residents with diabetes, 87 (38%) were not taking any antidiabetic medication. Pharmacological management inconsistent with CPG recommendations was observed for 73 (32%) residents, with the most common reason for non-concordance being the use of medications with significant adverse effects in older adults (47, 2%). Residents with hypertension or other heart diseases in addition to their diabetes had greater odds of their diabetes management being non-concordant with CPGs (OR = 2.84 95% CI = 1.54, 5.3 and OR = 2.64, 95% CI = 1.07, 6.41, respectively). CONCLUSIONS Pharmacological diabetes management in metropolitan Australian RACFs is suboptimal, with a high prevalence of inconsistency with CPGs (32%) observed. Additionally, having hypertension or heart diseases significantly increased the possibility of non-concordance among diabetic RACF residents. Further investigation into the underlying relationships with comorbidities is required to develop better strategies.
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Affiliation(s)
- Hargun Bhalla
- Faculty of Medicine, Health, and Human Sciences (FMHHS), Macquarie University, Sydney, New South Wales, Australia
| | - Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - S Sandun Malpriya Silva
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bosco Wu
- Faculty of Medicine, Health, and Human Sciences (FMHHS), Macquarie University, Sydney, New South Wales, Australia
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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2
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Wondimkun YA, Caughey GE, Inacio MC, Hughes GA, Air T, Jorissen RN, Hogan M, Sluggett JK. National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities. Diabetes Res Clin Pract 2024; 212:111701. [PMID: 38719026 DOI: 10.1016/j.diabres.2024.111701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
AIMS To examine national trends in glucose lowering medicine (GLM) use among older people with diabetes in long-term care facilities (LTCFs) during 2009-2019. METHODS A repeated cross-sectional study of individuals ≥65 years with diabetes in Australian LTCFs (n = 140,322) was conducted. Annual age-sex standardised prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Multivariable Poisson or Negative binomial regression models were used to estimate adjusted rate ratios (aRRs) and 95 % confidence intervals (CIs). RESULTS Prevalence of GLM use remained steady between 2009 (63.9%, 95 %CI 63.3-64.4) and 2019 (64.3%, 95 %CI 63.9-64.8) (aRR 1.00, 95 %CI 1.00-1.00). The percentage of residents receiving metformin increased from 36.0% (95 %CI 35.3-36.7) to 43.5% (95 %CI 42.9-44.1) (aRR 1.01, 95 %CI 1.01-1.01). Insulin use also increased from 21.5% (95 %CI 21.0-22.0) to 27.0% (95 %CI 26.5-27.5) (aRR 1.02, 95 %CI 1.02-1.02). Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95 %CI 0.9-1.1) to 21.1% (95 %CI 20.7-21.5) (aRR 1.24, 95 %CI 1.24-1.25), while sulfonylurea use decreased from 34.4% (95 %CI 33.8-35.1) to 19.3% (95 %CI 18.9-19.7) (aRR 0.93, 95 %CI 0.93-0.94). Similar trends were observed in DDDs/1000 resident days. CONCLUSIONS The increasing use of insulin and ongoing use of sulfonylureas suggests a need to implement evidence-based strategies to optimise diabetes care in LTCFs.
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Affiliation(s)
- Yohanes A Wondimkun
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Hawassa University, College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia.
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Georgina A Hughes
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Michelle Hogan
- Australian Government Aged Care Quality and Safety Commission, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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3
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 13. Older Adults: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S244-S257. [PMID: 38078580 PMCID: PMC10725804 DOI: 10.2337/dc24-s013] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the 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, an interprofessional 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 and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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4
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Zhao L, Xu F, Zheng X, Xu Z, Osten B, Ji K, Ding S, Liu G, Yang S, Chen R. Mediation role of anxiety on social support and depression among diabetic patients in elderly caring social organizations in China during COVID-19 pandemic: a cross-sectional study. BMC Geriatr 2023; 23:790. [PMID: 38041007 PMCID: PMC10691130 DOI: 10.1186/s12877-023-04502-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Diabetes has become a prominent global public health problem, which is an important cause of death, disease burden, and medical and health economic burden. Previous studies have reported that majority of persons diagnosed with diabetes later presented with psychological and mental health diseases. The study aimed to explore the mediation role of anxiety on social support and depression among diabetic patents in elderly caring social organizations (SOs). METHODS A multi-stage stratified cluster random sampling method was used in this cross-sectional study, and a questionnaire consisting of demographic questionnaire, MSPSS, GAD-7, and CES-D-10 was utilized to gather data. SPSS 22.0 and MPLUS 7.4 were used for statistical analysis. Spearman correlation analysis was employed to investigate correlations of key variables. A generalized linear model was used to exam factors associated with depression. Finally, the mediation effect among study variables was investigated by structural equation modeling (SEM). RESULTS The average scores of social support, anxiety, and depression were 58.41 ± 14.67, 2.95 ± 3.95, and 7.24 ± 5.53, respectively. The factors of gender, social support, and anxiety were identified as significantly influential factors related to depression among diabetic patients in elderly caring SOs. The effect of social support on depression was significantly mediated by anxiety (β = -0.467, 95%CI: -0.813 to -0.251). Furthermore, anxiety partially mediated the relationship between family support and depression (β = -0.112, 95%CI: -0.229 to -0.012), and anxiety functioned as a complete mediator in the effect of significant others' support and depression (β = -0.135, 95%CI: -0.282 to -0.024). CONCLUSIONS The indirect effect of social support on depression through anxiety among diabetic patients in elderly caring SOs was elucidated. Social support played a key role in maintaining and regulating their mental health, particularly from family and significant others. Social support provided by both family and significant others exerted an important influence on maintaining and regulating their mental health. In light of this pathway, the elderly caring SOs should enhance the magnitude of social support from these two sources, thereby diminishing the likelihood of experiencing anxiety and depression.
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Affiliation(s)
- Lanlan Zhao
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Fuqin Xu
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Xin Zheng
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Ziwen Xu
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Benjamin Osten
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
- Registrars' Department, University of Cape Coast, Cape Coast, Ghana
| | - Kai Ji
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Shuo Ding
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Guoqing Liu
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Shufan Yang
- School of Computing, Engineering and Built Environment, Edinburgh Napier University, Edinburgh, UK
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, UCL, London, UK
| | - Ren Chen
- School of Health Services Management, Anhui Medical University, Hefei, 230032, China.
- Key Laboratory of Public Health Social Governance, Philosophy and Social Sciences of Anhui Province, Hefei, China.
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5
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Huang ES, Sinclair A, Conlin PR, Cukierman-Yaffe T, Hirsch IB, Huisingh-Scheetz M, Kahkoska AR, Laffel L, Lee AK, Lee S, Lipska K, Meneilly G, Pandya N, Peek ME, Peters A, Pratley RE, Sherifali D, Toschi E, Umpierrez G, Weinstock RS, Munshi M. The Growing Role of Technology in the Care of Older Adults With Diabetes. Diabetes Care 2023; 46:1455-1463. [PMID: 37471606 PMCID: PMC10369127 DOI: 10.2337/dci23-0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/24/2023] [Indexed: 07/22/2023]
Abstract
The integration of technologies such as continuous glucose monitors, insulin pumps, and smart pens into diabetes management has the potential to support the transformation of health care services that provide a higher quality of diabetes care, lower costs and administrative burdens, and greater empowerment for people with diabetes and their caregivers. Among people with diabetes, older adults are a distinct subpopulation in terms of their clinical heterogeneity, care priorities, and technology integration. The scientific evidence and clinical experience with these technologies among older adults are growing but are still modest. In this review, we describe the current knowledge regarding the impact of technology in older adults with diabetes, identify major barriers to the use of existing and emerging technologies, describe areas of care that could be optimized by technology, and identify areas for future research to fulfill the potential promise of evidence-based technology integrated into care for this important population.
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Affiliation(s)
| | | | - Paul R. Conlin
- Harvard Medical School, Boston, MA
- Veteran Affairs Boston Healthcare System, Boston, MA
| | - Tali Cukierman-Yaffe
- Division of Endocrinology, Diabetes, and Metabolism, Ramat Gan, Israel
- Sheba Medical Centre, Ramat Gan, Israel
- Epidemiology Department, Sackler Faculty of Medicine, Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | - Sei Lee
- University of California San Francisco, San Francisco, CA
| | | | - Graydon Meneilly
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Naushira Pandya
- Department of Geriatrics, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL
| | | | - Anne Peters
- University of Southern California, Los Angeles, CA
| | - Richard E. Pratley
- AdventHealth Diabetes Institute, AdventHealth Translational Research Institute, AdventHealth, Orlando, FL
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Vergely N. Ten-Year Prospective Follow-Up of Institutionalized Patients With Diabetes in a Long-Term Care Home. Clin Diabetes 2023; 41:339-350. [PMID: 37456103 PMCID: PMC10338266 DOI: 10.2337/cd22-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Clinical practice recommendations advise individualizing diabetes treatment for elderly people, especially those living in long-term care facilities. Elderly patients face one of two main risks: either excessive treatment leading to hypoglycemia or insufficient treatment leading to progression of complications and excess mortality. This article describes a 10-year prospective observational study of people with diabetes in a long-term care home to determine the effect of routine glucose monitoring and monthly evaluation by a diabetes specialist with a goal of improving A1C. Its findings suggest that minimal glucose monitoring and monthly medical follow-up can optimize patient outcomes and help to maintain quality of life without over-medicalization of older people with diabetes in institutional settings.
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Affiliation(s)
- Nathalie Vergely
- Maison de Retraite de la Loire, Saint Just Saint Rambert, France
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7
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Jeffrie Seley J, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 13. Older Adults: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S216-S229. [PMID: 36507638 PMCID: PMC9810468 DOI: 10.2337/dc23-s013] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the 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 and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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8
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Chen SM, Wu CJ. Development and validation of a Perceived Relocation Stress Scale for older individuals transferred to long-term care facilities in Taiwan. Int Health 2022:6612122. [PMID: 35726866 DOI: 10.1093/inthealth/ihac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of the current study was to develop and validate a Perceived Relocation Stress Scale. METHODS A cross-sectional research design was used. A total of 175 older adults residing in long-term care facilities in Southern Taiwan for at least 1 y were recruited. An exploratory factor analysis was performed to examine item convergent and discriminant validity. Concurrent validity was checked using the Depression Anxiety and Stress scale. The reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients. RESULTS The face and content validity of the scale were verified by adequately measuring the scale items. Factor analysis consisted of four components (challenge/chance, positive appraisal, threat, loss), with a total variance of 67.35%. The content validity was determined by an expert panel to systematically examine the relevance of all items. The results of item convergent and discriminant validity supported the constructs of the scale. The alpha coefficient for the overall scale was .958, indicating good internal consistency reliability. CONCLUSIONS The Perceived Relocation Stress Scale is a reliable and valid measurement to assess the stress perceived by older individuals being transferred to a long-term care facility.
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Affiliation(s)
- Shu-Ming Chen
- School of Nursing, Fooyin University, 151 Jinxue Road, Dailao Dist., Kaohsiung City, 83102, Taiwan
| | - Chiung-Jung Wu
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, 1 Moreton Parade, Petrie, QLD 4502, Australia.,Royal Brisbane and Women's Hospital (RBWH), Australia
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9
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Kolltveit BCH, Graue M, Orvik E, Fløde M, Haltbakk J. Diabetessykepleieres rolle i primærhelsetjenesten – en kvalitativ studie. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the 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 (https://doi.org/10.2337/dc22-SPPC), 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 (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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Bouillet B, Tscherter P, Vaillard L, Nonciaux C, Hourdain P, Ravier A, Rouland A, Petit JM, Vergès B, Quilot E. Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes. Age Ageing 2021; 50:2088-2093. [PMID: 34324624 DOI: 10.1093/ageing/afab128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is ≥8% for institutionalised patients with treatments that can cause hypoglycaemia. PURPOSE We aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. DESIGN Prospective, multicentre study carried out in six geriatric care centres in the Côte d'Or region of France between January 2019 and July 2020. SETTINGS, SUBJECTS AND METHODS A FreeStyle Libre Pro® (FSLP) was worn for up to 14 days in blinded mode in 42 patients taking at least one potentially hypoglycaemia-inducing antidiabetic drug. RESULTS Two hundred and forty-two hypoglycaemic events were detected in 79% (n = 33) of patients wearing the FSLP. One or more hypoglycaemic event was detected in 100% of patients with HbA1C < 7% and in 79% of patients with HbA1C ≥ 8% (P = 0.02). The time spent in hypoglycaemia was higher in patients with HbA1C < 7% than those with HbA1C ≥ 8% (P = 0.015). Time spent <54 mg/dl was detected in 45% of patients. CONCLUSIONS We report a very high prevalence of hypoglycaemia, with a significant proportion of severe hypoglycaemia, in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs. Having HbA1C < 7% exposes patients to a higher risk of hypoglycaemia, but this risk remains also high in patients with HbA1C ≥ 8%. In this population, continuous glucose monitoring could be considered an effective tool to detect hypoglycemia, which is associated with increased risk of cardiovascular events, falling, fractures, cognitive impairment and mortality.
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Affiliation(s)
- Benjamin Bouillet
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Pauline Tscherter
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
| | | | | | | | | | - Alexia Rouland
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Jean Michel Petit
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Bruno Vergès
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Emilienne Quilot
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
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12
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Stasinopoulos J, Wood SJ, Bell JS, Manski-Nankervis JA, Hogan M, Sluggett JK. Potential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review. J Am Med Dir Assoc 2021; 22:1889-1897.e5. [PMID: 34004183 DOI: 10.1016/j.jamda.2021.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the prevalence, outcomes, and factors associated with potential glycemic overtreatment and undertreatment of type 2 diabetes mellitus (T2DM) in long-term care facilities (LTCFs). DESIGN Systematic review. SETTING AND PARTICIPANTS Residents with T2DM and aged ≥60 years living in LTCFs. MEASURES Articles published between January 2000 and September 2020 were retrieved following a systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL plus, and gray literature. Inclusion criteria were the reporting of (1) potential overtreatment and undertreatment quantitatively defined (implicitly or explicitly) based on hemoglobin A1c (HbA1c) and/or blood glucose; (2) prevalence, outcomes, and associated factors of potential glycemic overtreatment and undertreatment; and (3) the study involved residents of LTCFs. RESULTS Fifteen studies were included. Prevalence of potential overtreatment (5%-86%, n = 15 studies) and undertreatment (1.4%-35%, n = 8 studies) varied widely among facilities and geographical locations, and according to definitions used. Prevalence of potential overtreatment was 16%-74% when defined as treatment with a glucose-lowering medication in a resident with ≥1 hypoglycemia risk factor or serious comorbidity, together with a HbA1c <7% (n = 10 studies). Potential undertreatment was commonly defined as residents on glucose-lowering medication having HbA1c >8.5% and the prevalence 1.4%-14.8% (n = 6 studies). No studies prospectively measured resident health outcomes from overtreatment and undertreatment. Potential overtreatment was positively associated with use of oral glucose-lowering medications, dementia diagnosis or dementia severity, and/or need for assistance with activities of daily living (n = 2 studies). Negative association was found between potential overtreatment and use of insulin/combined insulin and oral glucose-lowering medication. No studies reported factors associated with potential undertreatment. CONCLUSIONS AND IMPLICATIONS The prevalence of potential glycemic overtreatment and undertreatment varied widely among residents with T2DM depending on the definition(s) used in each study. Longitudinal studies examining associations between glycemic management and health outcomes, and the use of consensus definitions of overtreatment and undertreatment are required to establish findings about actual glycemic overtreatment and undertreatment in LTCFs.
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Affiliation(s)
- Jacquelina Stasinopoulos
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - Stephen J Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | | | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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13
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Libiseller A, Lichtenegger KM, de Campo A, Wiesinger T, Cuder G, Donsa K, Höll B, Beck P, Plank J, Schippinger W, Pieber TR. Diabetes Management According to Health Status in Older Adults with Type 2 Diabetes Staying in Geriatric Care Facilities. J Diabetes Sci Technol 2021; 15:615-621. [PMID: 32054294 PMCID: PMC8120046 DOI: 10.1177/1932296820905827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND About 25% of adults >70 years suffer from type 2 diabetes. Due to the heterogeneity of the geriatric population, guidelines emphasize the need to individualize glycemic goals and simplify treatment strategies with the main focus of avoiding hypoglycemia. The aim of this study was to assess glycemic control in patients with type 2 diabetes in geriatric care facilities based on their individual health status. METHODS 170 medical records of older adults with type 2 diabetes in geriatric care facilities were retrospectively assessed (64.7% female, age 80 ± 9 years; glycated hemoglobin 6.8% ± 3.6% [51 ± 16 mmol/mol]; body mass index 27.9 ± 5.8 kg/m2). Based on the individual health status, patients were allocated to three groups (healthy n = 27, complex n = 86, and poor n = 57). RESULTS The overall blood glucose (BG) value was highest in the poor health group with 188 ± 47 mg/dL (poor) vs 167 ± 42 mg/dL (complex) vs 150 ± 34 mg/dL (healthy). BG values of 1.6% (poor) vs 2.8% (complex) vs 1.5% (healthy) of patients were below 90 mg/dL. 36.8% (poor) vs 23.4% (complex) vs 18.5% (healthy) of patients received insulin as the main diabetes therapy, but of these only 14.3% (poor) vs 20% (complex) vs 40% (healthy) were treated with basal insulin. CONCLUSIONS Overall, BG values were higher in the poor and complex health group. There were a few low BG values in all groups. Although recommended by international guidelines, basal insulin therapy with its low complexity and low hypoglycemic risk is still underused, especially in the poor health group. Therefore, simplification of diabetes therapy should be considered further.
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Affiliation(s)
- Angela Libiseller
- Division of Endocrinology and
Diabetology, Medical University of Graz, Austria
| | | | | | | | - Gerald Cuder
- Division of Endocrinology and
Diabetology, Medical University of Graz, Austria
| | - Klaus Donsa
- JOANNEUM RESEARCH
ForschungsgesellschaftmbH, Graz, Steiermark, Austria
| | - Bernhard Höll
- JOANNEUM RESEARCH
ForschungsgesellschaftmbH, Graz, Steiermark, Austria
| | - Peter Beck
- JOANNEUM RESEARCH
ForschungsgesellschaftmbH, Graz, Steiermark, Austria
| | - Johannes Plank
- Division of Endocrinology and
Diabetology, Medical University of Graz, Austria
| | | | - Thomas R. Pieber
- Division of Endocrinology and
Diabetology, Medical University of Graz, Austria
- JOANNEUM RESEARCH
ForschungsgesellschaftmbH, Graz, Steiermark, Austria
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14
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Lorber M, Kmetec S, Mlinar Reljić N, Fekonja Z. Diabetes management of older adults in nursing homes: A retrospective study. J Nurs Manag 2021; 29:1293-1301. [PMID: 33482053 DOI: 10.1111/jonm.13268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
AIM To examine the diabetes management of older adults in nursing homes. BACKGROUND Diabetes is an increasing problem in nursing homes, and diabetes care is defined as a neglected clinical area. METHODS A retrospective collected data review of 166 older adults with known diabetes from four nursing homes. RESULTS 65% older than 75 years had HbA1c levels lower than 7.5% (58 mmol/mol), 74% older than 85 years had HbA1c levels lower than 8% (64 mmol/mol). The HbA1c levels were 7.3% (56 mmol/mol) for those who had three and more chronic disorders and 6.8% (51 mmol/mol) for those who had less than three chronic disorders. Individuals treated with insulin had higher HbA1c levels (p < .001) and glycaemia (p = .002). Age was associated with a number of chronic disorders (p = .031), a number of regularly prescribed medications (p = .038) and a number of medications as needed (p = .009). CONCLUSIONS More than half to three quarters have diabetes well-managed. Nevertheless, there is still some potential for improving diabetes care, and these findings warrant further research for improving diabetes management of older adults in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT Interventions designed to promote a healthy lifestyle, documenting individuals' target level and regular monitoring of glycaemia and HbA1c levels may help to improve diabetes management, which may result in better well-being and quality of life for older adults with diabetes in nursing homes.
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Affiliation(s)
- Mateja Lorber
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Sergej Kmetec
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | | | - Zvonka Fekonja
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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15
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Carrillo Algarra AJ, Beltrán KM, Bolivar Castro DM, Hernández Zambrano SM, Henao Carrillo DC. Cuidados de enfermería para la persona adulta, diabética con hipoglucemia: revisión integrativa. REPERTORIO DE MEDICINA Y CIRUGÍA 2021. [DOI: 10.31260/repertmedcir.01217372.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: La hipoglucemia es la complicación más frecuente del tratamiento con insulina en adultos. Los eventos de hipoglucemia severa se asocian con complicaciones a corto, mediano y largo plazo en pacientes con diabetes ellmitus. Una de las estrategias para reducir la frecuencia de hipoglucemia son las intervenciones de enfermería y aunque hay pocos estudios que las enuncian de manera explícita, se ha publicado respecto a las necesidades de dichos pacientes, que permiten determinar características definitorias de diagnósticos enfermeros y a partir de ellos establecer metas e intervenciones enfermeras, para el cuidado de dichos pacientes. Objetivo: identificar los cuidados de enfermería para prevenir y controlar los eventos de hipoglucemia en pacientes adultos diagnosticados con diabetes mellitus. Metodología: revisión integrativa, se realizó en seis fases: planteamiento de la pregunta PICO; búsqueda en bases de datos y metabuscadores; lectura crítica; análisis, clasificación, validación por nivel de evidencia y grado de recomendación, y presentación de la información. Resultados: la revisión reportó cinco categorías: factores de riesgo y protectores, miedo a la hipoglucemia, atención brindada al paciente, disminución de la hipoglucemia y descripción del impacto de la hipoglucemia en los pacientes. Conclusiones: a partir de las necesidades reportadas en las 5 categorías de los resultados se determinaron características definitorias y factores relacionados que permitieron formular diagnósticos de enfermería y determinar como principales intervenciones: enseñanza del proceso de enfermedad, medicamentos prescritos, entrenamiento de asertividad, manejo de la hipoglicemia, nutricional y de la medicación, mejorar el afrontamiento, enseñanza individual, facilitar el aprendizaje y potenciación de la disposición de aprendizaje.
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16
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Continuous glucose monitoring in older people with diabetes receiving home care-a feasibility study. Pilot Feasibility Stud 2021; 7:12. [PMID: 33407924 PMCID: PMC7786485 DOI: 10.1186/s40814-020-00754-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background Hypoglycemic incidents in older people can cause severe health problems, enhance general age-related disabilities, and cause frailty. Little is known about incidences of hypoglycemia in older home-dwelling people with diabetes. Thus, the aim of this study was to examine the feasibility of capturing hypoglycemia and issues associated with increased risk of hypoglycemia by use of continuous glucose monitoring (CGM) and standardized questionnaires among older home-dwelling individuals with diabetes type 2 receiving home care. Methods CGM with the Ipro2-blinded monitoring system were performed for 5 days in six home-dwelling individuals ≥ 75 years diagnosed with diabetes and receiving home care. Demographic (age, gender, living arrangements) and clinical data (diabetes diagnoses and duration, diabetes medication, documented treatment goal, available glycosylated hemoglobin (HbA1c)) were collected from electronic patient records in home care services. Feasibility (ease of use, quality of data, time spent) of standardized questionnaires to identify the risk of hypoglycemia (the McKellar Risk Assessment Tool), risk of malnutrition (the Mini Nutritional Assessment (MNA)), functional status (the Individual-based Statistics for Nursing and Care Services (IPLOS)), and cognitive status (the Mini Mental Status Exam (MMSE)) was also assessed. Questionnaire data was collected by a study nurse in the individuals’ home. Results The practical use of CGM was satisfactory, with no major remarks about discomfort or technical errors, except for one participant with skin reaction (redness). Collecting data with the McKellar Risk Assessment Tool, MNA and IPLOS worked well according to quality of data, time spent, and ease of use. The MMSE survey required extensive training of personnel to be conducted. Conclusion The feasibility study informs an upcoming study on the incidence and risk factors of hypoglycemia in home-dwelling older individuals. We will ascertain that personnel who will use the MMSE questionnaire to collect cognitive status and skills are familiar with the tool and adequately educated and trained before study start. The use of blinded CGM in this population was well tolerated and can be used “as is” for future studies.
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17
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the 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 (https://doi.org/10.2337/dc21-SPPC), 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 (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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18
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Slåtsve KB, Claudi T, Lappegård KT, Jenum AK, Larsen M, Cooper JG, Sandberg S, Julsrud Berg T. The total prevalence of diagnosed diabetes and the quality of diabetes care for the adult population in Salten, Norway. Scand J Public Health 2020; 50:161-171. [PMID: 32854596 PMCID: PMC8873303 DOI: 10.1177/1403494820951004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the total prevalence of types 1 and 2 diabetes and to describe and compare cardiovascular risk factors, vascular complications and the quality of diabetes care in adults with types 1 and 2 diabetes in Salten, Norway. Research design and methods: Cross-sectional study including all patients with diagnosed diabetes in primary and specialist care in Salten, 2014 (population 80,338). Differences in cardiovascular risk factors, prevalence of vascular complications and attained treatment targets between diabetes types were assessed using regression analyses. Results: We identified 3091 cases of diabetes, giving a total prevalence in all age groups of 3.8%, 3.4% and 0.45% for types 2 and 1 diabetes, respectively. In the age group 30–89 years the prevalence of type 2 diabetes was 5.3%. Among 3027 adults aged 18 years and older with diabetes, 2713 (89.6%) had type 2 and 304 (10.0%) type 1 diabetes. The treatment target for haemoglobin A1c (⩽7.0%/53 mmol/mol) was reached in 61.1% and 22.5% of types 2 and 1 diabetes patients, respectively. After adjusting for age, sex and diabetes duration we found differences between patients with types 2 and 1 diabetes in mean haemoglobin A1c (7.1% vs. 7.5%, P<0.001), blood pressure (136/78 mmHg vs. 131/74 mmHg, P<0.001) and prevalence of coronary heart disease (23.1% vs. 15.8%, P<0.001). Conclusions: The prevalence of diagnosed type 2 diabetes was slightly lower than anticipated. Glycaemic control was not satisfactory in the majority of patients with type 1 diabetes. Coronary heart disease was more prevalent in patients with type 2 diabetes.
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Affiliation(s)
- Kristina B. Slåtsve
- Department of Medicine, Nordland Hospital, Norway
- Kristina B. Slåtsve, Department of Medicine, Nordland Hospital, Prinsens gate 164, 8005 Bodø, Norway.
| | - Tor Claudi
- Department of Medicine, Nordland Hospital, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordland Hospital, Norway
- Department of Clinical Medicine, The Arctic University of Norway, Norway
| | - Anne K. Jenum
- General Practice Research Unit (AFE), University of Oslo, Norway
| | - Marthe Larsen
- Clinical Research Department, University Hospital of North Norway, Norway
| | - John G. Cooper
- Department of Medicine, Stavanger University Hospital, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Norway
- Department of Public Health and Primary Health Care, University of Bergen, Norway
- Department of Clinical Biochemistry, Haukeland University Hospital, Norway
| | - Tore Julsrud Berg
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
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Quilot E, Petit JM, Vergès B, Bouillet B. Are older patients with diabetes still being overtreated in French long-term care homes? Age Ageing 2020; 49:878-882. [PMID: 32457990 DOI: 10.1093/ageing/afaa051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diabetes management has not been evaluated in French nursing homes (NHs) for 10 years. OBJECTIVES The present study aimed to compare the management of diabetes with guidelines in older patients living in NHs. DESIGN Observational, retrospective and multicentre study carried out in 13 NH in the Cote d'Or region of France. SETTINGS AND SUBJECTS Between January and June 2018, all NH residents older than 65 years and known to have diabetes (n = 148) were included. METHODS Epidemiological, clinical and biological data and diabetes characteristics were collected from the medical records. RESULTS The average glycated haemoglobin (HbA1C) was 7.2 ± 1.2%. In total, 51% of patients had HbA1C < 7% (n = 70), of which 39 took one or more antidiabetic drugs. In total, 28 of those patients (40%) were at risk of developing hypoglycaemia as a result of their treatment. In all, 44.6% of patients were treated with insulin. Glinides were the most commonly prescribed oral antidiabetic drug (OAD) (27%). Capillary blood glucose monitoring (CBGM) was not carried out daily for 75% of patients taking a potentially hypoglycaemia-inducing OAD. CONCLUSIONS We found that glycaemic control was too tight in at least 36.5% of the total population and that 40% of patients with HbA1C < 7% were potentially overtreated. The use of dipeptidyl peptidase 4 (DPP-4) inhibitors was still insufficient, as was CBGM. Avoiding hypoglycaemia is one of the priorities in the management of older patients with diabetes. Therefore, NHs should focus on improving the use of glycaemic targets and antidiabetic drugs that do not induce hypoglycaemia, as well as better monitoring of capillary blood glucose.
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Affiliation(s)
- Emilienne Quilot
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
| | - Jean-Michel Petit
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Bruno Vergès
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | - Benjamin Bouillet
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
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20
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Da Porto A, Coracina A, Fiore V, Masi S, Fontana L, Marnini P, Felace G. Quality of care to institutionalized patients with diabetes in Italy: a national survey. Eur Geriatr Med 2020; 11:753-759. [PMID: 32504422 DOI: 10.1007/s41999-020-00329-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the epidemiology of diabetes and quality of care of institutionalized patients with diabetes in Italian nursing homes. More specifically, to evaluate the adherence to the national/international guidelines for the management of older people with diabetes. METHODS Data related to the epidemiology of diabetes and the quality of care were collected from questionnaires sent to 41 nursing homes. Data were extracted from papers, electronic medical records and validated operating protocols regulating the management of patients with diabetes in various homes. Completed questionnaires were returned in electronic format and centrally processed. RESULTS Out of 4692 residents, 906 (19.3%) had diabetes. Among these residents, excluding patients undergoing diet treatment, more than half were on insulin treatment (alone or in combination with oral antidiabetic agents). The critical findings can be summarized as follows: a lack of shared diagnostic-therapeutic protocols, specifically related to evaluation of frailty; the preparation of nutritional and physical activity plans; the clarification of the objectives of the treatment; the timing of insulin administration (frequent use of sliding scale); the frequency and timing of capillary blood glucose; metabolic control methods; hypoglycemia and hyperglycemia treatment; and the scant use of new drugs that do not cause hypoglycemia. CONCLUSION Our data revealed substantial heterogeneity in the treatment of nursing home residents with diabetes in Italy with many discrepancies between what is recommended in the guidelines and real-world practice. The implementation of local diagnostic-therapeutic protocols shared by all caregivers should be encouraged and properly funded to overcome communication problems between doctors and nurses and eventually improve the quality of care for institutionalized patients with diabetes.
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Affiliation(s)
| | - Anna Coracina
- Diabetologic Unit of Cittadella (PD), Cittadella, Italy
| | - Vincenzo Fiore
- Internal and Geriatric Medicine Unit Tivoli (RM), Tivoli, Italy
| | - Stefano Masi
- Diabetes Unit of Nocera Inferiore (SA) and Ottaviano (NA), Ottaviano, Italy
| | - Lucia Fontana
- Ambulatorial Activities ACISMOM (Latina and Viterbo), Viterbo, Italy
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21
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Glycemic control and use of glucose-lowering medications in hospital-admitted type 2 diabetes patients over 80 years. Sci Rep 2020; 10:4095. [PMID: 32139733 PMCID: PMC7057984 DOI: 10.1038/s41598-020-60818-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/27/2020] [Indexed: 01/16/2023] Open
Abstract
Treatment guidelines for type 2 diabetes (T2D) recommend avoidance of hypoglycemia and less stringent glycemic control in older patients. We examined the relation of glycemic control to glucose-lowering medications use in a cohort of patients aged>80 years with a diagnosis of T2D and a hospital admission in the Capital Region of Denmark in 2012-2016. We extracted data on medication use, diagnoses, and biochemistry from the hospitals' records. We identified 5,172 T2D patients with high degree of co-morbidity and where 17% had an HbA1c in the range recommended for frail, comorbid, older patients with type 2 diabetes (58-75 mmol/mol (7.5-9%)). Half of the patients (n = 2,575) had an HbA1c <48 mmol/mol (<6.5%), and a majority of these (36% of all patients) did not meet the diagnostic criteria for T2D. Of patients treated with one or more glucose-lowering medications (n = 1,758), 20% had HbA1c-values <42 mmol/mol (<6%), and 1% had critically low Hba1c values <30 mmol/mol (<4.9%), In conclusion, among these hospitalized T2D patients, few had an HbA1c within the generally recommended glycemic targets. One third of patients did not meet the diagnostic criteria for T2D, and of the patients who were treated with glucose-lowering medications, one-fifth had HbA1c-values suggesting overtreatment.
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22
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Chen SM, Lin HS, Atherton JJ, MacIsaac RJ, Wu CJJ. Effect of a mindfulness programme for long-term care residents with type 2 diabetes: A cluster randomised controlled trial measuring outcomes of glycaemic control, relocation stress and depression. Int J Older People Nurs 2020; 15:e12312. [PMID: 32103635 DOI: 10.1111/opn.12312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/09/2020] [Accepted: 01/18/2020] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this study was to determine physical, behavioural and psychosocial effects of a newly developed mindfulness programme for older adults with type 2 diabetes relocating to long-term care facility. BACKGROUND Taiwan is viewed as an "aged society" with significant proportion of the population living in a long-term care facility. Approximately one third of residents living in long-term care facilities have been diagnosed with type 2 diabetes, and disruption to management of their glycaemic levels is at risk for up to one year after relocating to a long-term care facility. DESIGN A cluster randomised controlled trial was used to examine the effects of a newly developed mindfulness programme on outcomes of glycaemic levels, relocation stress and depression. METHODS A total of 140 participants were recruited from six long-term care facilities in Southern Taiwan. A mindfulness programme was delivered over 9 weeks and consisted of meditations, education and exercise techniques that were delivered by a Registered Nurse trained in mindfulness strategies. Participants in the control group received routine care as provided in the facilities, including routine check-ups at diabetes clinics as necessary. Data were analysed by Johnson-Neyman technique and generalised estimating equations. RESULTS In total, 120 residents completed the study. The majority of patients were female (64.8%), and 83.5% of the sample were financially supported by their children. The results showed significant improvements in glycated haemoglobin (HbA1c), relocation stress (Wald χ2 = 78.91) and depression (Wald χ2 = 45.70) between groups. In the intervention group, the mean of HbA1c levels showed 16.4% reduction (Mean differences = 1.3; SD = 0.3). However, there were no significant differences in relocation stress and depression within groups. CONCLUSION The results provided positive effects of the mindfulness programme for older people with diabetes moving into long-term care facilities. The programme will assist in future planning for diabetes care in long-term care facilities. IMPLICATIONS FOR PRACTICE To incorporate the mindfulness program into existing diabetes education programs for older people living in LTCFs. Further investigation on the sustainability of the mindfulness program is warranted.
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Affiliation(s)
- Shu-Ming Chen
- Department of Nursing, School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.,Queensland University of Technology (QUT), Brisbane, Qld, Australia.,University of the Sunshine Coast (USC), Sippy Downs, Qld, Australia.,University of Queensland (UQ), St Lucia, Qld, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne & University of Melbourne, Fitzroy, Vic, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Qld, Australia.,Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.,Mater Medical Research Institute-University of Queensland (MMRI-UQ), South Brisbane, Qld, Australia
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23
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Álvarez-Najar JP, Valderrama-Sanabria ML, Peña-Pita AP. Beliefs and practices in diabetes care. DUAZARY 2020. [DOI: 10.21676/2389783x.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diabetes mellitus is considered a chronic non-communicable disease with high morbidity, presents to its high prevalence, social, family, and economic costs. Interventions aimed at life-style changes are fundamental in managing; due to this, patients must receive education. The aim of the study was to identify the beliefs and practices of the persons with diabetes mellitus, to propose nurse care according to these precepts. This was a descriptive study of systematic literature review, searching for articles in databases, Springer Science, Elsevier, ProQuest, Science Direct, Index, Pubmed, SciELO, Medigraphic, and Medline during 2016 to 2018, published between 2001 and 2018, in Spanish, English, and Portuguese. A total of 49 studies were contributing to fulfilling the objective. Within the beliefs for the management of disease, is the use of herbs, some consider as cause "fright"; Others take into account risk factors such as heredity, obesity, poor eating habits. Various beliefs are presented in relation to insulin treatment. Spirituality is emphasized; seeking refuge in God and prayer. Is important to understand the person, from their values, beliefs, customs and feelings. Education is a fundamental tool to control the disease, but health beliefs must be taken into account in order to achieve favorable results.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the 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 (https://doi.org/10.2337/dc20-SPPC), 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 (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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25
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Hambling CE, Khunti K, Cos X, Wens J, Martinez L, Topsever P, Del Prato S, Sinclair A, Schernthaner G, Rutten G, Seidu S. Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe. Prim Care Diabetes 2019; 13:330-352. [PMID: 30792156 DOI: 10.1016/j.pcd.2018.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 12/23/2022]
Abstract
Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.
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Affiliation(s)
- C E Hambling
- Department of Public Health and Primary Care, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - J Wens
- Department of Medicine and Health Sciences, Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - L Martinez
- Department of General Medicine, Pierre and Marie Curie University, Paris, France
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey
| | - S Del Prato
- Department of Clinical and Experimental Medicine, Section of Diabetes, University of Pisa, Pisa, Italy
| | - A Sinclair
- Foundation for Diabetes Research in Older People (FDROP), Diabetes Frail, Luton, United Kingdom
| | - G Schernthaner
- Department of Medicine 1, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria
| | - G Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, University, Utrecht, the Netherlands
| | - S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
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Hatano Y, Araki A, Matsumoto M, Ishibashi S. 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. Geriatr Gerontol Int 2019; 19:854-860. [DOI: 10.1111/ggi.13728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Yu Hatano
- School of Public Health, University of California, Berkeley Berkeley California USA
| | - Atsushi Araki
- Department of Diabetes, Metabolism and EndocrinologyTokyo Metropolitan Geriatric Medical Center Tokyo Japan
| | - Masatoshi Matsumoto
- Department of Community‐Based Medical System, Graduate School of Biomedical and Health SciencesHiroshima University Hiroshima Japan
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal MedicineJichi Medical University Tochigi Japan
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Abstract
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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Hart HE, Ditzel K, Rutten GE, de Groot E, Seidu S, Khunti K, Vos RC. De-Intensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study. Patient Prefer Adherence 2019; 13:1775-1783. [PMID: 31695339 PMCID: PMC6804671 DOI: 10.2147/ppa.s208947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate if, one year after notification of possible overtreatment, diabetes care providers de-intensified glucose-lowering medications and to gain insight into the opinions and beliefs of both care providers and patients regarding de-intensification. METHODS Mixed methods using routine care data from five health-care centres in the Netherlands. Patient characteristics and medication prescription of patients, previously identified as possibly over-treated, were extracted from patients' medical records. Opinions of care providers were obtained through interviews. Patients received questionnaires about their diabetes treatment and were asked to participate in focus groups. RESULTS A total of 64 elderly patients with type 2 diabetes were previously identified as possibly over-treated and included; 57.8% male, median age 75 years (IQR=72-82), median diabetes duration 12 years (IQR=8-18). De-intensification was implemented in more than half (n=36) of them. Care providers preferred person-centred care above just setting general HbA1c target values, considering patient characteristics (such as comorbidity) and patient's preference. Patients valued glucose levels as most important in determining their treatment. Both patients and care providers felt that de-intensification should occur gradually. CONCLUSION Treatment had been de-intensified in more than half of the patients (56.3%). Insight in reasons for not de-intensifying elderly patients is important since treatment for them can be "person-centred care". De-intensification is an iterative and time-intensive process.
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Affiliation(s)
- Huberta E Hart
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Leidsche Rijn Julius Health Centers, Utrecht, The Netherlands
- Correspondence: Huberta E Hart Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Erasmuslaan 68, Zeist3707 ZE, The NetherlandsTel +31 6 1695 0844 Email
| | - Kim Ditzel
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Guy E Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Rimke C Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Public Health and Primary Care/lumc-Campus the Hague, Leiden University Medical Center, The Hague, The Netherlands
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Titlestad I, Haugstvedt A, Igland J, Graue M. Patient safety culture in nursing homes - a cross-sectional study among nurses and nursing aides caring for residents with diabetes. BMC Nurs 2018; 17:36. [PMID: 30100816 PMCID: PMC6081853 DOI: 10.1186/s12912-018-0305-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 07/22/2018] [Indexed: 01/07/2023] Open
Abstract
Background Due to the high morbidity and disability level among diabetes patients in nursing homes, the conditions for caregivers are exceedingly complex and challenging. The patient safety culture in nursing homes should be evaluated in order to improve patient safety and the quality of care. Thus, the aim of this study was to examine the perceptions of patient safety culture of nursing personnel in nursing homes, and its associations with the participants’ (i) profession, (ii) education, (iii) specific knowledge related to their own residents with diabetes, and (iv) familiarity with clinical diabetes guidelines for older people. Methods Cross-sectional survey design. The study included 89 nursing home personnel (38 registered nurses and 51 nurse aides), 25 (28%) with advanced education, at two nursing homes. We collected self-reported questionnaire data on age, profession, education and work experience, diabetes knowledge and familiarity with diabetes guidelines. In addition, we applied the Nursing Home Survey on Patient Safety Culture instrument, with 42 items and 12 dimensions. Results In general, those with advanced education scored higher in all patient safety culture dimensions than those without, however statistically significant only for the dimensions “teamwork” (mean score 81.7 and 67.7, p = 0.042) and “overall perceptions of resident safety” (mean score 90.0 and 74.3, p = 0.016). Nursing personnel who were familiar with diabetes guidelines for older people had more positive perceptions in key areas of patient safety culture, than those without familiarity with the guidelines. Conclusions The findings from this study show that advanced education and familiarity with current diabetes guidelines was related to adequate evaluations on essential areas of patient safety culture in nursing homes.
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Affiliation(s)
- Irit Titlestad
- 1Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, N-5020 Bergen, Norway.,Kleppestø Nursing Home, Askøy Municipality, Bergen, Norway
| | - Anne Haugstvedt
- 1Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, N-5020 Bergen, Norway
| | - Jannicke Igland
- 1Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, N-5020 Bergen, Norway.,3Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- 1Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Postbox 7030, N-5020 Bergen, Norway
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30
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Alitta Q, Grino M, Adjemout L, Langar A, Retornaz F, Oliver C. Overestimation of Hypoglycemia Diagnosis by FreeStyle Libre Continuous Glucose Monitoring in Long-Term Care Home Residents With Diabetes. J Diabetes Sci Technol 2018; 12:727-728. [PMID: 29251062 PMCID: PMC6154245 DOI: 10.1177/1932296817747887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Quentin Alitta
- Silvermed Institute, State Geriatric
Center, Marseille, France
| | - Michel Grino
- Silvermed Institute, State Geriatric
Center, Marseille, France
- Michel Grino, MD, PhD, Silvermed Institute,
State Geriatric Center, 176 Avenue de Montolivet, 13012 Marseille, France.
| | - Lounés Adjemout
- Division of Geriatric Medicine, State
Geriatric Center, Marseille, France
| | - Aïda Langar
- Silvermed Institute, State Geriatric
Center, Marseille, France
| | - Frédérique Retornaz
- Silvermed Institute, State Geriatric
Center, Marseille, France
- Division of Geriatric Medicine, State
Geriatric Center, Marseille, France
- Department of Public Health, EA3279
Self-Perceived Health Assessment Research Unit, Marseille, France
- Marseille’s Medical School,
Aix-Marseille University, Marseille, France
- Department of Internal Medicine,
European Hospital, Marseille, France
| | - Charles Oliver
- Silvermed Institute, State Geriatric
Center, Marseille, France
- Division of Geriatric Medicine, State
Geriatric Center, Marseille, France
- Marseille’s Medical School,
Aix-Marseille University, Marseille, France
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Abstract
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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32
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Kostev K, Rockel T, Jacob L. Prescription Patterns and Disease Control in Type 2 Diabetes Mellitus Patients in Nursing Home and Home Care Settings: A Retrospective Analysis in Germany. J Diabetes Sci Technol 2018; 12:136-139. [PMID: 28539088 PMCID: PMC5761966 DOI: 10.1177/1932296817710477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to analyze prescription patterns and disease control in patients with type 2 diabetes mellitus (T2DM) in nursing home and home care settings in Germany. METHODS The present study is based on data from the Disease Analyzer database (QuintilesIMS). Patients with an initial diagnosis of T2DM and documented HbA1c values between January 2011 and December 2015 were included in the analysis. The index date corresponded to the last documented HbA1c value. Patients in nursing homes were matched (1:1) with patients living at home based on age, gender, and dementia diagnosis. The first outcome of the study was the share of use of several antidiabetic drugs in the two different settings. The second outcome was the mean HbA1c value and the proportion of patients with HbA1c values lower than 7% in the two different groups. RESULTS In this study, 4925 individuals lived in nursing homes and 4925 individuals lived at home. The mean age was 80.7 years (SD = 7.7). Prescription patterns differed significantly between nursing home and home care settings: insulin (57.9% vs 41.1%), metformin (46.6% vs 60.5%), sulfonylurea (24.9% vs 34.2%), DPP4 inhibitors (13.4% vs 19.8%), and other antihyperglycemic drugs (7.8% vs 12.1%). In contrast, mean HbA1c values (nursing home: 7.2%; home: 7.2%) and the share of patients with Hb1Ac values lower than 7% (nursing home: 49.1%; home: 50.9%) did not differ significantly between the two groups. CONCLUSION Overall, the differences in prescription patterns between nursing homes and home care were not associated with significant differences in the management of T2DM.
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Affiliation(s)
- Karel Kostev
- QuintilesIMS, Frankfurt, Germany
- Karel Kostev, PhD, Epidemiology, QuintilesIMS, Darmstädter Landstraße 108, Frankfurt am Main, 60598, Germany.
| | | | - Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
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Hambling CE, Seidu SI, Davies MJ, Khunti K. Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies. Diabet Med 2017; 34:1219-1227. [PMID: 28498634 DOI: 10.1111/dme.13380] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 01/11/2023]
Abstract
AIM To evaluate potential overtreatment with sulfonylurea and insulin therapies amongst older people with Type 2 diabetes, including those with chronic kidney disease or dementia. METHODS Using the ECLIPSE Live software tool, we developed a search to examine data on older people (age ≥ 70 years) with Type 2 diabetes, who were prescribed sulfonylurea or insulin therapies over the previous 90 days. Sixteen Norfolk general practices participated, representing a population of 24 661 older people, including 3862 (15.7%) with Type 2 diabetes. Of these, 1379 (35.7%) people were prescribed sulfonylurea or insulin therapies. Data extracted included age, sex, last recorded HbA1c value, renal function and dementia codes. RESULTS The median age of the study cohort was 78 years. A total of 644 people (47.8%) had chronic kidney disease (estimated GFR < 60 mL/min/1.73m2 ) and 60 people (4.35%) had dementia. The median (interquartile range) HbA1c concentration for the entire cohort was 58 (51-69) mmol/mol [7.5 (6.8-8.5)%], with no difference in median HbA1c between those with or without either chronic kidney disease or dementia. In total, 400 older people (29.9%) had an HbA1c concentration < 53 mmol/mol (7%), of whom 162 (12.1%) had HbA1c < 48 mmol/mol (6.5%). Stratified by prescription for sulfonylurea, insulin or combined insulin and sulfonylurea therapies, 282 (35.2%), 93 (24.2%) and 25 people (16.3%), respectively, had HbA1c < 53 mmol/mol (7.0%). Treatment to an HbA1c target of < 53 mmol/mol (7.0%) was as prevalent in those with chronic kidney disease or dementia as in those without. CONCLUSION In the present cohort of older people with Type 2 diabetes prescribed sulfonylurea or insulin therapies, overtreatment was common, even in the presence of comorbidities known to increase hypoglycaemia risk.
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Affiliation(s)
- C E Hambling
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester
- West Norfolk Clinical Commissioning Group, King's Lynn, Norfolk
| | - S I Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester
- University Hospitals of Leicester NHS Trusts, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester
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Hurley L, O'Donnell M, O'Caoimh R, Dinneen SF. Investigating the management of diabetes in nursing homes using a mixed methods approach. Diabetes Res Clin Pract 2017; 127:156-162. [PMID: 28371686 DOI: 10.1016/j.diabres.2017.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/16/2017] [Indexed: 01/21/2023]
Abstract
AIMS As populations age there is an increased demand for nursing home (NH) care and a parallel increase in the prevalence of diabetes. Despite this, there is growing evidence that the management of diabetes in NHs is suboptimal. The reasons for this are complex and poorly understood. This study aimed to identify the current level of diabetes care in NHs using a mixed methods approach. METHODS The nursing managers at all 44 NHs in County Galway in the West of Ireland were invited to participate. A mixed methods approach involved a postal survey, focus group and telephone interviews. RESULTS The survey response rate was 75% (33/44) and 27% (9/33) of nursing managers participated in the qualitative research. The reported prevalence of diagnosed diabetes was 14% with 80% of NHs treating residents with insulin. Hypoglycaemia was reported as 'frequent' in 19% of NHs. A total of 36% of NHs have staff who have received diabetes education or training and 56% have access to diabetes care guidelines. Staff education was the most cited opportunity for improving diabetes care. Focus group and interview findings highlight variations in the level of support provided by GPs and access to dietetic, podiatry and retinal screening services. CONCLUSIONS There is a need for national clinical guidelines and standards of care for diabetes management in nursing homes, improved access to quality diabetes education for NH staff, and greater integration between healthcare services and NHs to ensure equity, continuity and quality in diabetes care delivery.
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Affiliation(s)
- L Hurley
- Diabetes and Endocrinology Centre, Galway University Hospitals, Health Service Executive, Newcastle Road, Galway, Ireland.
| | - M O'Donnell
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
| | - R O'Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
| | - S F Dinneen
- Diabetes and Endocrinology Centre, Galway University Hospitals, Health Service Executive, Newcastle Road, Galway, Ireland; Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
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Patell R, Nigmatoulline D, Bena J, Kim DG, Messinger-Rapport B, Lansang MC. HYPERGLYCEMIA AND HYPOGLYCEMIA IN PATIENTS WITH DIABETES IN SKILLED NURSING FACILITIES. Endocr Pract 2017; 23:458-465. [PMID: 28156156 DOI: 10.4158/ep161502.or] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Endocrinologists are faced with a growing elderly patient population with diabetes mellitus (DM), some of whom are in skilled nursing facilities (SNFs). Efforts at managing their DM is hampered by concerns for hypoglycemia. This study aimed to determine the frequency of hypo- and hyperglycemia in SNFs, and associated factors. METHODS We reviewed medical records of 200 consecutive residents admitted to two SNFs in the Cleveland area in 2014 with documented DM, aged ≥65 years. Data collected included blood glucose (BG) levels and DM regimens. Frequency of hyper- and hypoglycemic events was noted. Since patients had different frequencies of BG checks, event-days were calculated. RESULTS Mean age, BG, and glycated hemoglobin (±SD) were as follows: 80.2 ± 8.2 years, 172.4 ± 40.3 mg/dL, and 7.5 ± 1.9% (59 mmol/mol), respectively. Seventy-one percent were on insulin alone, 15.5% on insulin and oral diabetes agents, and 13.5% on oral diabetes agent on admission. Patients with at least one event were as follows: 38% hypoglycemia, 3.5% severe hypoglycemia, 90.5% hyperglycemia, and 15% severe hyperglycemia. Event-days were: 3.4% hypoglycemia and 52.4% hyperglycemia. Risk of hypoglycemia was highest with concomitant sulfonylurea and prandial or sliding-scale insulin. Hyperglycemia risk was high in basal insulin-containing regimens. CONCLUSION Hypoglycemia was seen in one-third of patients, and hyperglycemia was common despite insulin use. Concomitant use of sulfonylurea and prandial or sliding-scale insulin is best avoided in this fragile population with hypo- and hyperglycemia. ABBREVIATIONS ADA = American Diabetes Association BG = blood glucose DM = diabetes mellitus GLP-1 = glucagon-like peptide 1 HBA1c = glycated hemoglobin LOS = length of stay NPH = neutral protamine Hagedorn SNF = skilled nursing facility SSI = sliding-scale insulin.
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36
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Retornaz F, Grino M, Mari L, Oliver C. Assessment of Glycemic Control in Nursing Home Residents with Diabetes. J Nutr Health Aging 2017; 21:457-463. [PMID: 28346573 DOI: 10.1007/s12603-016-0776-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe glycemic control in nursing home residents with diabetes and to evaluate the relevance of HbA1c in the detection of hypoglycemia risk. DESIGN AND METHODS Diabetes treatment, geriatric assessment, blood capillary glucose (n= 24,682), and HbA1c were collected from medical charts of 236 southern France nursing home residents during a 4-month period. Glycemic control was divided into four categories: tight, fair, and moderate or severe chronic hyperglycemia using the High Blood Glucose Index or the analysis of blood glucose frequency distribution. Hypoglycemia episodes were identified by medical or biological records. RESULTS Glucose control was tight in 59.3 % and fair in 19.1 % of the residents. Chronic exposure to hyperglycemia was observed in 21.6 % of the residents (severe in 9.7 % and moderate in 11.9 %). Hypoglycemia was noticed in 42/236 (17.8%), in all categories of glycemic control. Relative hypoglycemia risk was significantly (P = 0.0095) higher in residents with moderate chronic hyperglycemia compared with those with tight control. The majority of residents with hypoglycemia (39/42) or chronic hyperglycemia (45/51) were insulin-treated. The relative risk of hypoglycemia was not significantly associated with HbA1c values. CONCLUSION Hypoglycemia risk in nursing home residents is observed in all categories of glycemic control. In tight control, the potency of antidiabetic treatment should be reduced. In chronic hyperglycemia, diet and treatment should be reevaluated in order to reduce glucose variability. HbA1c is not sufficient for hypoglycemia risk detection; capillary blood glucose monitoring is warranted for nursing homes residents with diabetes.
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Affiliation(s)
- F Retornaz
- Dr Charles Oliver, Division of Geriatric Medicine, State Geriatric Centre, 176 Avenue de Montolivet, 13012 Marseille, Tel: 04 91 12 75 49, Fax: 04 91 12 75 52, e-mail:
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Haugstvedt A, Graue M, Aarflot M, Heimro LS, Johansson H, Hjaltadottir I, Sigurdardottir AK. Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/20573316.2016.1262588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Anne Haugstvedt
- Department of Nursing, Bergen University College, Bergen, Norway
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
| | - Marit Graue
- Department of Nursing, Bergen University College, Bergen, Norway
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
| | - Morten Aarflot
- Department of Community Medicine, The Arctic University of Norway
| | | | | | - Ingibjörg Hjaltadottir
- Faculty of Nursing, University of Iceland, Reykjavik, Iceland
- National University Hospital Iceland, Reykjavik, Iceland
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Andreassen LM, Granas AG, Sølvik UØ, Kjome RLS. ‘I try not to bother the residents too much’ – the use of capillary blood glucose measurements in nursing homes. BMC Nurs 2016; 15:7. [PMID: 26855612 PMCID: PMC4743135 DOI: 10.1186/s12912-016-0129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/26/2016] [Indexed: 01/21/2023] Open
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Haugstvedt A, Aarflot M, Igland J, Landbakk T, Graue M. Diabetes knowledge in nursing homes and home-based care services: a validation study of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel. BMC Nurs 2016; 15:40. [PMID: 27366112 PMCID: PMC4928289 DOI: 10.1186/s12912-016-0159-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing high-quality diabetes care in nursing homes and home-based care facilities requires suitable instruments to evaluate the level of diabetes knowledge among the health-care providers. Thus, the aim of this study was to examine the psychometric properties of the Michigan Diabetes Knowledge Test adapted for use among nursing personnel. METHODS The study included 127 nursing personnel (32 registered nurses, 69 nursing aides and 26 nursing assistants) at three nursing homes and one home-based care facility in Norway. We examined the reliability and content and construct validity of the Michigan Diabetes Knowledge Test. RESULTS The items in both the general diabetes subscale and the insulin-use subscale were considered relevant and appropriate. The instrument showed satisfactory properties for distinguishing between groups. Item response theory-based measurements and item information curves indicate maximum information at average or lower knowledge scores. Internal consistency and the item-total correlations were quite weak, indicating that the Michigan Diabetes Knowledge Test measures a set of items related to various relevant knowledge topics but not necessarily related to each other. CONCLUSIONS The Michigan Diabetes Knowledge Test measures a broad range of topics relevant to diabetes care. It is an appropriate instrument for identifying individual and distinct needs for diabetes education among nursing personnel. The knowledge gaps identified by the Michigan Diabetes Knowledge Test could also provide useful input for the content of educational activities. However, some revision of the test should be considered.
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Affiliation(s)
- Anne Haugstvedt
- Faculty of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Post Box 7030, N-5020 Bergen, Norway
| | - Morten Aarflot
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Post Box 7030, N-5020 Bergen, Norway ; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Marit Graue
- Faculty of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Post Box 7030, N-5020 Bergen, Norway
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40
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Andreassen LM, Kjome RLS, Sølvik UØ, Houghton J, Desborough JA. The potential for deprescribing in care home residents with Type 2 diabetes. Int J Clin Pharm 2016; 38:977-84. [PMID: 27241345 PMCID: PMC4929175 DOI: 10.1007/s11096-016-0323-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/13/2016] [Indexed: 01/21/2023]
Abstract
Background Type 2 diabetes is a common diagnosis in care home residents that is associated with potentially inappropriate prescribing and thus risk of additional suffering. Previous studies found that diabetes medicines can be safely withdrawn in care home residents, encouraging further investigation of the potential for deprescribing amongst these patients. Objectives Describe comorbidities and medicine use in care home residents with Type 2 diabetes; identify number of potentially inappropriate medicines prescribed for these residents using a medicines optimisation tool; assess clinical applicability of the tool. Setting Thirty care homes for older people, East Anglia, UK. Method Data on diagnoses and medicines were extracted from medical records of 826 residents. Potentially inappropriate medicines were identified using the tool 'Optimising Safe and Appropriate Medicines Use'. Twenty percent of results were validated by a care home physician. Main outcome measure Number of potentially inappropriate medicines. Results The 106 residents with Type 2 diabetes had more comorbidities and prescriptions than those without. Over 90 % of residents with Type 2 diabetes had at least one potentially inappropriate medication. The most common was absence of valid indication. The physician unreservedly endorsed 39 % of the suggested deprescribing, and would consider discontinuing all but one of the remaining medicines following access to additional information. Conclusion UK care home residents with Type 2 diabetes had an increased burden of comorbidities and prescriptions. The majority of these patients were prescribed potentially inappropriate medicines. Validation by a care home physician supported the clinical applicability of the medicines optimisation tool.
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Affiliation(s)
- Lillan Mo Andreassen
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, 5020, Bergen, Norway.
| | - Reidun Lisbet Skeide Kjome
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, 5020, Bergen, Norway
| | - Una Ørvim Sølvik
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, 5020, Bergen, Norway
| | - Julie Houghton
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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41
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Abstract
Management of diabetes in the elderly necessitates careful consideration of concomitant geriatric syndromes and comorbid conditions that increase the risk of complications, including severe hypoglycemia. Whereas healthy older adults can use therapeutic approaches recommended for their younger counterparts, treatment plans for frail elderly patients need to be simplified and A1c and blood pressure goals relaxed with the development of impairments in function, cognition, vision, and dexterity. The goals of diabetes management in the elderly should be to maintain quality of life and minimize symptomatic hyperglycemia and drug side effects, including hypoglycemia.
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Affiliation(s)
- Nidhi Bansal
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Ruban Dhaliwal
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Ruth S Weinstock
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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