[Treatment quality in geriatric patients with diabetes mellitus in various home environments].
OBJECTIVE
The goal of the present study was to systematically assess treatment quality, perceptions, and cognitive function of elderly patients with diabetes admitted to an acute geriatric hospital from different home environments (nursing home residents, home care, assisted living, family caregivers, self-sufficient).


METHODS
Quality of diabetes treatment, metabolic control (HbA(1c)), nutrition, treatment satisfaction, cognition, disability, and level of dependency were assessed in 128 patients with diabetes.


RESULTS
Out of 128 patients, 87 patients (68%) showed an HbA1c≤8% according to the guidelines for aging people with diabetes of the German Diabetes Association (DDG). Compared to patients living independently at home, the metabolic control in nursing home residents and their treatment satisfaction were as good. They had a higher degree of dependency though (Barthel, p<0.001), more strongly impaired mobility (Tinetti, p<0.01), less diabetes knowledge (p<0.001), inferior cognitive performance (MMSE, SPMSQ, p<0.01), and a higher prevalence of depression (GDS) (p<0.01). Better cognitive function correlated with better diabetes knowledge (r=0.49; p<0.001), but not with better metabolic control.


CONCLUSIONS
The treatment of geriatric patients with diabetes mellitus requires individual considerations and interdisciplinary care. Particularly the continuing education of geriatric nurses could contribute to improved diabetes treatment quality in nursing home residents.
Bahrmann
A
A
Bethanien-Krankenhaus, Geriatrisches Zentrum an der Ruprecht-Karls-Universität Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany. abahrmann@bethanien-heidelberg.de
Abel
Al
A
Specht-Leible
N
N
Abel
Am
A
Wörz
E
E
Hölscher
E
E
Zieschang
T
T
Oster
P
P
Zeyfang
A
A
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000592:standards; D017028:Caregivers; D015897:Comorbidity; D003858:Dependency, Psychological; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004185:Disability Evaluation; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D006699:Home Care Services / Q000592:standards; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D057187:Independent Living; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D051346:Mobility Limitation; D009735:Nursing Homes / Q000592:standards; D009752:Nutritional Status; D010343:Patient Admission; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D012648:Self Care / Q000592:standards
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Lancet. 1999 Jan 16;353(9148):205-6
9923878
Exp Clin Endocrinol Diabetes. 2001;109(6):326-9
11571670
Med Klin (Munich). 2000 Nov 15;95(11):608-12
11143540
Diabetes Care. 1999 Mar;22(3):530-2
10097946
Diabet Med. 2004 Sep;21(9):999-1006
15317605
MMW Fortschr Med. 2009 May 14;151(20):38-40
19728662
J Psychiatr Res. 1982-1983;17(1):37-49
7183759
J Am Geriatr Soc. 1986 Feb;34(2):119-26
3944402
Nervenarzt. 1990 Aug;61(8):495-8
2234226
J Am Geriatr Soc. 1975 Oct;23(10):433-41
1159263
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
Age Ageing. 2009 Jul;38(4):390-6
19454403
N Engl J Med. 2008 Feb 7;358(6):580-91
18256393
Z Arztl Fortbild Qualitatssich. 2007;101(9):623-9
18269054