title: Diabetes Management in Long-Term Care: An Exploratory Study of the Current Practices and Processes to Managing Frail Elderly Persons with Type 2 Diabetes.
abstract: OBJECTIVE
  There is limited evidence for the management of diabetes in frail elderly residents living in long-term care (LTC) settings. The purpose of this study was to explore the current practices of glycemic management in frail elderly persons with diabetes living in LTC settings.
  
  
  METHODS
  Using a mixed-methods convergent parallel design, this study surveyed medical directors and attending physicians of long-term care centres through an online questionnaire and one-on-one semistructured interviews.
  
  
  RESULTS
  A total of 39 questionnaires were completed, representing a variety of LTC settings, including private and public settings. Diabetes management practices varied across the participating settings with respect to glucose targets, with 69% of respondents selecting glycated hemoglobin levels of 8% or greater as being appropriate for LTC residents. Blood glucose monitoring, pharmacotherapy, presence of comorbidities, frailty and life expectancy were highlighted as variables for consideration in diabetes management in LTC. Interviews with attending physicians further illustrated the variability of opinions related to the use of clinical practice guidelines, glucose target levels and intensity of management (i.e. blood glucose monitoring and pharmacotherapy).
  
  
  CONCLUSIONS
  The findings of this study were triangulated with both the quantitative survey and the qualitative interviews. The implications of these findings suggest a disparity between what physicians feel should be achieved for diabetes management and what is actually done for frail elderly adults in LTC settings. Further research needs to be completed to assess the distinct needs and considerations of this unique population and healthcare setting.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Osman
authors.initials: O
authors.lastname: Osman
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: dsherif@mcmaster.ca.
authors.forename: Diana
authors.initials: D
authors.lastname: Sherifali
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Schlegel University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Heckman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002170:Canada; D003131:Combined Modality Therapy / Q000639:trends; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000517:prevention & control / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D016330:Frail Elderly; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000639:trends; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D020407:Internet; D008017:Life Expectancy; D008134:Long-Term Care / Q000639:trends; D008486:Physician Executives; D010820:Physicians; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D000078329:Workforce
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: diabetes; diabète; elderly; fragilité; frail; la gestion; long-term care; management; personne âgée; soins de longue durée