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Published in: Current Diabetes Reports 3/2014

01-03-2014 | Hospital Management of Diabetes (G Umpierrez, Section Editor)

Diabetes in Long-Term Care Facilities

Authors: Aaditya Singhal, Alissa R. Segal, Medha N. Munshi

Published in: Current Diabetes Reports | Issue 3/2014

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Abstract

With the aging of the population and longer life expectancies, the prevalence of population with multiple chronic medical conditions has increased. Difficulty managing these conditions as people age (because of changes in physical, functional, or cognitive abilities and the complexity of many treatment regimens), has led to more individuals with multiple medical conditions admitted to the long-term care facilities. Older adults with diabetes residing in the long-term facilities represent the most vulnerable of this cohort. Studies that specifically target diabetes management in older population are lacking and those that target diabetes management in the long-term care facilities are even fewer. The lack of knowledge regarding the care of the elderly residing in long-term care with diabetes may lead to treatment failure and higher risk of hyperglycemia, as well as hypoglycemia. In aging populations, hypoglycemia has the potential for catastrophic consequences. To avoid this, the management of older population with diabetes and other medical comorbidities residing in long-term care facilities requires a more holistic approach compared with focusing on individual chronic disease goal achievement.
Literature
1.••
go back to reference Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60:2342–56. This consensus paper delineates available evidence and consideration for issues that may influence treatment decisions in older adults with diabetes.CrossRef Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60:2342–56. This consensus paper delineates available evidence and consideration for issues that may influence treatment decisions in older adults with diabetes.CrossRef
2.••
go back to reference Association AMD. Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline. In: Columbia, MD: AMDA; 2008; revised 2010. These revised guidelines are the most up-to-date recommendations providing practical guidance for management of diabetes in long-term care settings. Association AMD. Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline. In: Columbia, MD: AMDA; 2008; revised 2010. These revised guidelines are the most up-to-date recommendations providing practical guidance for management of diabetes in long-term care settings.
3.
go back to reference Munshi M. Managing the “geriatric syndrome” in patients with type 2 diabetes. Consult Pharm. 2008;23(Suppl B):12–6.PubMed Munshi M. Managing the “geriatric syndrome” in patients with type 2 diabetes. Consult Pharm. 2008;23(Suppl B):12–6.PubMed
4.
go back to reference Holt RM, Schwartz FL, Shubrook JH. Diabetes care in extended-care facilities: appropriate intensity of care? Diabetes Care. 2007;30:1454–8.PubMedCrossRef Holt RM, Schwartz FL, Shubrook JH. Diabetes care in extended-care facilities: appropriate intensity of care? Diabetes Care. 2007;30:1454–8.PubMedCrossRef
5.•
go back to reference National Diabetes Fact Sheet. General Information and National Estimates on Diabetes in United States. In: U.S. Department of Health and Human Services CDC (ed.) Atlanta, GA; 2011. This data sheet has the current prevalence of diabetes in various age groups and shows the burden of the disease and its complications in the U.S. National Diabetes Fact Sheet. General Information and National Estimates on Diabetes in United States. In: U.S. Department of Health and Human Services CDC (ed.) Atlanta, GA; 2011. This data sheet has the current prevalence of diabetes in various age groups and shows the burden of the disease and its complications in the U.S.
6.
go back to reference Zhang X, Decker FH, Luo H, et al. Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58:724–30.PubMedCrossRef Zhang X, Decker FH, Luo H, et al. Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58:724–30.PubMedCrossRef
7.
go back to reference Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in U.S. nursing homes, 2004. Diabetes Care. 2008;31:287–8.PubMedCrossRef Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in U.S. nursing homes, 2004. Diabetes Care. 2008;31:287–8.PubMedCrossRef
8.
go back to reference Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on diabetes in the elderly and in nursing home residents. J Am Med Dir Assoc. 2011;12:627–32 e2.PubMedCrossRef Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on diabetes in the elderly and in nursing home residents. J Am Med Dir Assoc. 2011;12:627–32 e2.PubMedCrossRef
9.••
go back to reference American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46. This article shows the true economical and social impact of diabetes in U.S. It shows the high socioeconomic impact of aging population.CrossRef American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46. This article shows the true economical and social impact of diabetes in U.S. It shows the high socioeconomic impact of aging population.CrossRef
10.
go back to reference Meneilly GS. The pathophysiology of diabetes in the elderly. In: Medha N, Munshi LAL, editors. Geriatric diabetes. New York: Informa Healthcare; 2007. p. 29–36.CrossRef Meneilly GS. The pathophysiology of diabetes in the elderly. In: Medha N, Munshi LAL, editors. Geriatric diabetes. New York: Informa Healthcare; 2007. p. 29–36.CrossRef
12.
go back to reference Elahi D, Muller DC, Egan JM, et al. Glucose tolerance, glucose utilization and insulin secretion in ageing. Novartis Found Symp. 2002;242:222–42. discussion 242–6.PubMedCrossRef Elahi D, Muller DC, Egan JM, et al. Glucose tolerance, glucose utilization and insulin secretion in ageing. Novartis Found Symp. 2002;242:222–42. discussion 242–6.PubMedCrossRef
13.
go back to reference Zeyda M, Stulnig TM. Obesity, inflammation, and insulin resistance—a mini-review. Gerontology. 2009;55:379–86.PubMedCrossRef Zeyda M, Stulnig TM. Obesity, inflammation, and insulin resistance—a mini-review. Gerontology. 2009;55:379–86.PubMedCrossRef
14.
go back to reference Blaum C. Diabetes mellitus. In: Durso S, Sullivan GM, editors. Geriatric review syllabus: a core curriculum in geriatric medicine. 8th ed. New York: American Geriatric Society; 2013. p. 566–75. Blaum C. Diabetes mellitus. In: Durso S, Sullivan GM, editors. Geriatric review syllabus: a core curriculum in geriatric medicine. 8th ed. New York: American Geriatric Society; 2013. p. 566–75.
15.
go back to reference Meneilly GS. Diabetes. In: Evans J, Williams TF, Beattie BL, editors. Textbook of geriatric medicine. 2nd ed. Oxford: Oxford University Press; 2000. p. 210–7. Meneilly GS. Diabetes. In: Evans J, Williams TF, Beattie BL, editors. Textbook of geriatric medicine. 2nd ed. Oxford: Oxford University Press; 2000. p. 210–7.
16.
go back to reference Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.PubMedCrossRef Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.PubMedCrossRef
17.
go back to reference Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.PubMedCrossRef Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.PubMedCrossRef
18.
go back to reference Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.PubMedCrossRef Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.PubMedCrossRef
19.
go back to reference Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009;32:187–92.PubMedCentralPubMedCrossRef Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009;32:187–92.PubMedCentralPubMedCrossRef
20.
go back to reference Bremer JP, Jauch-Chara K, Hallschmid M, et al. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32:1513–7.PubMedCentralPubMedCrossRef Bremer JP, Jauch-Chara K, Hallschmid M, et al. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32:1513–7.PubMedCentralPubMedCrossRef
21.
go back to reference Matyka K, Evans M, Lomas J, et al. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care. 1997;20:135–41.PubMedCrossRef Matyka K, Evans M, Lomas J, et al. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care. 1997;20:135–41.PubMedCrossRef
22.
go back to reference Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multi-center observational study. J Am Med Dir Assoc. 2013;14(11):842–6.PubMedCrossRef Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multi-center observational study. J Am Med Dir Assoc. 2013;14(11):842–6.PubMedCrossRef
23.
go back to reference Denardo SJ, Gong Y, Nichols WW, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010;123:719–26.PubMedCentralPubMedCrossRef Denardo SJ, Gong Y, Nichols WW, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010;123:719–26.PubMedCentralPubMedCrossRef
24.•
go back to reference Zhao W, Katzmarzyk PT, Horswell R, et al. Aggressive blood pressure control increases coronary heart disease risk among diabetic patients. Diabetes Care. 2013;36(10):3287–96. This prospective cohort study contributes to understanding of level of BP control in patients with coronary heart disease and diabetes. The study shows a "U" shaped associated between BP and risk of CHD suggesting that aggressive BP cotnrol is associated with increase risk of CHD in patients with diabetes.PubMedCrossRef Zhao W, Katzmarzyk PT, Horswell R, et al. Aggressive blood pressure control increases coronary heart disease risk among diabetic patients. Diabetes Care. 2013;36(10):3287–96. This prospective cohort study contributes to understanding of level of BP control in patients with coronary heart disease and diabetes. The study shows a "U" shaped associated between BP and risk of CHD suggesting that aggressive BP cotnrol is associated with increase risk of CHD in patients with diabetes.PubMedCrossRef
25.
go back to reference Sinclair A, Morley JE, Rodriguez-Manas L, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology. and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc. 2012;13:497–502.PubMedCrossRef Sinclair A, Morley JE, Rodriguez-Manas L, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology. and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc. 2012;13:497–502.PubMedCrossRef
26.•
go back to reference Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011;37 Suppl 3:S27–38. This positions statement delineates guidelines and opinons by an international panel of experts.PubMedCrossRef Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011;37 Suppl 3:S27–38. This positions statement delineates guidelines and opinons by an international panel of experts.PubMedCrossRef
27.
go back to reference Roussel R, Travert F, Pasquet B, et al. Metformin use and mortality among patients with diabetes and atherothrombosis. Arch Intern Med. 2010;170:1892–9.PubMedCrossRef Roussel R, Travert F, Pasquet B, et al. Metformin use and mortality among patients with diabetes and atherothrombosis. Arch Intern Med. 2010;170:1892–9.PubMedCrossRef
28.
go back to reference Lee CG, Boyko EJ, Barrett-Connor E, et al. Insulin sensitizers may attenuate lean mass loss in older men with diabetes. Diabetes Care. 2011;34:2381–6.PubMedCentralPubMedCrossRef Lee CG, Boyko EJ, Barrett-Connor E, et al. Insulin sensitizers may attenuate lean mass loss in older men with diabetes. Diabetes Care. 2011;34:2381–6.PubMedCentralPubMedCrossRef
29.
30.
go back to reference Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: systematic review and meta-analysis. JAMA. 2007;298:194–206.PubMedCrossRef Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: systematic review and meta-analysis. JAMA. 2007;298:194–206.PubMedCrossRef
31.
go back to reference Pratley RE, Rosenstock J, Pi-Sunyer FX, et al. Management of type 2 diabetes in treatment-naive elderly patients: benefits and risks of vildagliptin monotherapy. Diabetes Care. 2007;30:3017–22.PubMedCrossRef Pratley RE, Rosenstock J, Pi-Sunyer FX, et al. Management of type 2 diabetes in treatment-naive elderly patients: benefits and risks of vildagliptin monotherapy. Diabetes Care. 2007;30:3017–22.PubMedCrossRef
32.
go back to reference Karyekar CS, Ravichandran S, Allen E, et al. Tolerability and efficacy of glycemic control with saxagliptin in older patients (aged ≥65 years) with inadequately controlled type 2 diabetes mellitus. Clin Interv Aging. 2013;8:419–30.PubMedCentralPubMedCrossRef Karyekar CS, Ravichandran S, Allen E, et al. Tolerability and efficacy of glycemic control with saxagliptin in older patients (aged ≥65 years) with inadequately controlled type 2 diabetes mellitus. Clin Interv Aging. 2013;8:419–30.PubMedCentralPubMedCrossRef
33.
go back to reference UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRef UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRef
34.
go back to reference American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRef American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRef
35.
go back to reference van de Laar FA, Lucassen PL, Akkermans RP, et al. Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diabetes Care. 2005;28:154–63.PubMedCrossRef van de Laar FA, Lucassen PL, Akkermans RP, et al. Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diabetes Care. 2005;28:154–63.PubMedCrossRef
36.
go back to reference Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.PubMedCrossRef Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.PubMedCrossRef
38.
go back to reference Meier C, Kraenzlin ME, Bodmer M, et al. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008;168:820–5.PubMedCrossRef Meier C, Kraenzlin ME, Bodmer M, et al. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008;168:820–5.PubMedCrossRef
39.
go back to reference Colmers IN, Bowker SL, Majumdar SR, Johnson JA. Use of thiazolidinediones and the risk of bladder cancer among people with type 2 diabetes: a meta-analysis. CMAJ. 2012;184:E675–83.PubMedCentralPubMedCrossRef Colmers IN, Bowker SL, Majumdar SR, Johnson JA. Use of thiazolidinediones and the risk of bladder cancer among people with type 2 diabetes: a meta-analysis. CMAJ. 2012;184:E675–83.PubMedCentralPubMedCrossRef
40.
go back to reference Bode B, Sinclair A, Harris S, Vijapurkar U, Mayer C, Fung A, et al. Efficacy and safety of canagliflozin in older subjects with type 2 diabetes. In: The 73rd scientific sessions of the American Diabetes Association. Chicago, IL: Diabetes. 2013; p. LB-76. Bode B, Sinclair A, Harris S, Vijapurkar U, Mayer C, Fung A, et al. Efficacy and safety of canagliflozin in older subjects with type 2 diabetes. In: The 73rd scientific sessions of the American Diabetes Association. Chicago, IL: Diabetes. 2013; p. LB-76.
41.••
go back to reference Munshi MN, Pandya N, Umpierrez GE, et al. Contributions of basal and prandial hyperglycemia to total hyperglycemia in older and younger adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2013;61:535–41. This meta-analysis provides important information about differences in hyperglycemia patterns in old vs young patients. This information can be used to target hyperglycemia differently in older patients and avoid treatment induced hypoglycemia.PubMedCrossRef Munshi MN, Pandya N, Umpierrez GE, et al. Contributions of basal and prandial hyperglycemia to total hyperglycemia in older and younger adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2013;61:535–41. This meta-analysis provides important information about differences in hyperglycemia patterns in old vs young patients. This information can be used to target hyperglycemia differently in older patients and avoid treatment induced hypoglycemia.PubMedCrossRef
42.
go back to reference Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361:1736–47.PubMedCrossRef Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361:1736–47.PubMedCrossRef
43.
go back to reference Karnieli E, Baeres FM, Dzida G, et al. Observational study of once-daily insulin detemir in people with type 2 diabetes aged 75 years or older: a sub-analysis of data from the Study of Once daily LeVEmir (SOLVE). Drugs Aging. 2013;30:167–75.PubMedCentralPubMedCrossRef Karnieli E, Baeres FM, Dzida G, et al. Observational study of once-daily insulin detemir in people with type 2 diabetes aged 75 years or older: a sub-analysis of data from the Study of Once daily LeVEmir (SOLVE). Drugs Aging. 2013;30:167–75.PubMedCentralPubMedCrossRef
44.
go back to reference Alissa R, Segal P, Munshi MN. Insulin therapy for older adults with diabetes. Geriatr Aging. 2008;11:357–62. Alissa R, Segal P, Munshi MN. Insulin therapy for older adults with diabetes. Geriatr Aging. 2008;11:357–62.
45.
go back to reference Pandya N, Nathanson E. Managing diabetes in long-term care facilities: benefits of switching from human insulin to insulin analogs. J Am Med Dir Assoc. 2010;11:171–8.PubMedCrossRef Pandya N, Nathanson E. Managing diabetes in long-term care facilities: benefits of switching from human insulin to insulin analogs. J Am Med Dir Assoc. 2010;11:171–8.PubMedCrossRef
46.
go back to reference American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care. 1998;21:296–309.CrossRef American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care. 1998;21:296–309.CrossRef
Metadata
Title
Diabetes in Long-Term Care Facilities
Authors
Aaditya Singhal
Alissa R. Segal
Medha N. Munshi
Publication date
01-03-2014
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 3/2014
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-013-0464-y

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