Prevalence, quality of care, and complications in long term care residents with diabetes: a multicenter observational study.
BACKGROUND
Few studies have reported on the quality of diabetes care and glycemic control adjusted for medication use in long term care (LTC) facilities.


METHODS
This observational study analyzed diabetes prevalence and management and the impact of glycemic control on clinical outcome in elderly subjects admitted to 3 community LTC facilities.


RESULTS
Among 1409 LTC residents (age 79.7 ± 12 years), the prevalence of diabetes was 34.2%. Subjects with diabetes were either on no pharmacological agents (10%) or were treated with sliding scale regular insulin (SSI, 25%), oral antidiabetic drugs (OAD, 5%), insulin (34%), or with combination of OAD and insulin (26%). Patients with diabetes had a mean daily BG of 156 ± 39 mg/dL and a mean admission HbA1c of 6.7% ± 1.1%. Compared with nondiabetes, residents with diabetes had higher number of complications (54% vs 45%, P < .001), infections (26% vs 21%, P = .036), emergency room (ER) and hospital transfers (37% vs 30%, P = .003), but similar mortality (15% vs 14%, P = .56). A total of 43% of residents with diabetes had a BG less than 70 mg/dL, and those with hypoglycemia had longer median length of stay (LOS, 52 vs 29 days, P < .001), more ER or hospital transfers (56% vs 69%, P = .005), and mortality (20% vs 10%, P = .002) compared with residents without hypoglycemia.


CONCLUSIONS
Diabetes is common in LTC residents and is associated with higher resource utilization and complications. Hypoglycemia is common and is associated with increased need of emergency room visits and hospitalization and higher mortality. Our findings emphasize the need for randomized trials evaluating the impact of different approaches to glycemic management on clinical outcome in LTC residents with diabetes.
Department of Medicine, Emory University, Atlanta, GA.
Christopher A
CA
Newton
Saira
S
Adeel
Shadi
S
Sadeghi-Yarandi
Winter
W
Powell
Alexandra
A
Migdal
Dawn
D
Smiley
Darin
D
Olson
Rakhee
R
Chambria
Ingrid
I
Pinzon
Marcos
M
Toyoshima
Zobair
Z
Nagamia
Limin
L
Peng
Theodore
T
Johnson
Guillermo E
GE
Umpierrez
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008134:Long-Term Care; D008297:Male; D015995:Prevalence; D011787:Quality of Health Care; D012307:Risk Factors
Nursing home; basal insulin; hospital hyperglycemia; inpatient hyperglycemia; long term care; sliding scale insulin