title: Differences in diabetes management of nursing home patients based on functional and cognitive status.
abstract: OBJECTIVE
  To describe practice patterns regarding diabetes management among nursing home (NH) physicians and to identify variation in this practice based on patient characteristics.
  
  
  METHODS
  Mailed survey.
  
  
  METHODS
  Nursing home physicians from the American Medical Directors Association (AMDA) Foundation Long-Term Care Research Network (n = 142), as well as other members of AMDA who were Certified Medical Directors (CMD) (n = 68) and members who were not CMD certified (n = 45). Response rates to the survey were 51%, 33%, and 23%, respectively.
  
  
  METHODS
  Physician and facility characteristics were queried. Responses to 12 items pertaining to diabetes management and 5 items pertaining to use of specific oral diabetes medications were evaluated in the context of 3 different patient profiles that reflected different combinations of functional and cognitive impairment. Responses were based on the physicians' perception of how they manage diabetes under these specified patient profiles.
  
  
  RESULTS
  Responses from members of the Research Network indicated highly significant variability (P < .01) between the 3 patient profiles for all of the 12 management items. Ordering a special diet, monitoring lipid panel, and ordering routine ophthalmology was less likely for the patient profile with both functional and cognitive impairment (P < .01). These differences among the patient profiles for these 3 interventions were present in the responses from all 3 categories of physicians (Research Network, CMD, and non-CMD members of AMDA). There was no statistically significant variability among the 3 patient profiles for any of the 3 physician groups regarding the likelihood of using of any of the 5 classes of oral diabetic medications. Non-CMD physicians were more likely to have less NH experience; otherwise, there were no differences among the 3 physician groups.
  
  
  CONCLUSIONS
  Nursing home physicians appear to alter the approach to diabetes management based on the functional and/or cognitive status of the patient. This was particularly true for those physicians who were members of the AMDA Foundation Research Network. These findings have implications for initiatives designed to guide clinical practice as well as efforts by regulatory bodies to evaluate appropriate care. Further research is needed to measure the actual impact of different approaches to diabetes management on relevant outcomes in this population.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mmcnabne@jhmi.edu
authors.forename: Matthew K
authors.initials: MK
authors.lastname: McNabney
authors.forename: Naushira
authors.initials: N
authors.lastname: Pandya
authors.forename: Cletus
authors.initials: C
authors.lastname: Iwuagwu
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Patel
authors.forename: Paul
authors.initials: P
authors.lastname: Katz
authors.forename: Vicki
authors.initials: V
authors.lastname: James
authors.forename: Barbara
authors.initials: B
authors.lastname: Calabrese
authors.forename: Larry
authors.initials: L
authors.lastname: Lawhorne
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000032:analysis; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D048909:Diabetes Complications / Q000517:prevention & control / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005853:Geriatrics / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents