title: Diabetes mellitus, glycemic control, and pneumonia in long-term care facilities: a 2-year, prospective cohort study.
abstract: OBJECTIVE
  To determine the relationships among diabetes mellitus (DM), glycemic control, and long-term care facility (LTCF)-acquired pneumonia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Ten private LTCFs in Taiwan.
  
  
  METHODS
  Participants were 233 LTCF residents.
  
  
  METHODS
  Barthel index (BI), Charlson comorbidity index (CCI), hemoglobin A1c, episodes of LTCF-acquired pneumonia.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 233 residents (76.9 ± 10.6 years, 54.9% males, 27.9% diabetic) from 10 private LTCFs participated. There were 173 LTCF-acquired pneumonia episodes. The incidence of LTCF-acquired pneumonia between patients with and without diabetes, or between diabetic subjects with different status of glycemic control was similar. Adjusted for baseline BI, CCI, feeding tube placement, and baseline serum albumin, DM was not a significant risk factor for LTCF-acquired pneumonia. Poorer glycemic control (HbA1c >7%) was not a significant risk factor for LTCF-acquired pneumonia in diabetic subjects.
  
  
  CONCLUSIONS
  Tighter glycemic control did not protect diabetic LTCF residents from pneumonia. A prospective randomized controlled trial is needed to determine the optimal goal of glycemic control for LTCF residents.
authors.affiliation: Division of Geriatric Medicine, Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Peng
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Lin
authors.forename: Hsiu-Yun
authors.initials: HY
authors.lastname: Lai
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin