title: Adherence to national diabetes guidelines through monitoring quality indicators--A comparison of three types of care for the elderly with special emphasis on HbA1c.
abstract: OBJECTIVE
  To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.
  
  
  METHODS
  Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.
  
  
  RESULTS
  Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p < 0.001). The HbA1c value of ≤ 6.9% (52 mmol/mol) was achieved for 48% of those in nursing homes with medication, 35% and 39%, for those living at home with or without home health care, respectively. Insulin was used to a greater extent in nursing homes. Metformin was frequently used, even at reduced e-GFR. Systolic BP ≤ 140 mmHg was achieved by 71% vs 80% and 85% of those living at home, those with home health care and residents of nursing homes in the respective groups.
  
  
  CONCLUSIONS
  Adherence to guidelines was deficient particularly in nursing homes. Clearer guidelines and interventions aimed at the improvement of quality in diabetes care in elderly people and sustainable coordination between health care providers is needed.
authors: Blå Kustens Primary Health Care Centre, Rösvägen4, S-57251 Oskarshamn, Sweden. Electronic address: annsofien@ltkalmar.se.
authors: Ann-Sofie Nilsson
authors: AS
authors: Neumark
authors: Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
authors: Lars
authors: L
authors: Brudin
authors: Primary Health Centre Lindsdal, Kalmar, Sweden; Planning Division, Kalmar County Council, Kalmar, Sweden.
authors: Thomas
authors: T
authors: Neumark
mesh_terms: D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D019983:Guideline Adherence / Q000592:standards*; D006299:Health Services for the Aged / Q000592:standards*; D006699:Home Care Services; D006707:Homes for the Aged; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057187:Independent Living; D008297:Male; D009735:Nursing Homes; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D017064:Process Assessment, Health Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Elderly; Guidelines; Nursing home; Quality indicators