title: Investigating the management of diabetes in nursing homes using a mixed methods approach.
abstract: OBJECTIVE
  As populations age there is an increased demand for nursing home (NH) care and a parallel increase in the prevalence of diabetes. Despite this, there is growing evidence that the management of diabetes in NHs is suboptimal. The reasons for this are complex and poorly understood. This study aimed to identify the current level of diabetes care in NHs using a mixed methods approach.
  
  
  METHODS
  The nursing managers at all 44 NHs in County Galway in the West of Ireland were invited to participate. A mixed methods approach involved a postal survey, focus group and telephone interviews.
  
  
  RESULTS
  The survey response rate was 75% (33/44) and 27% (9/33) of nursing managers participated in the qualitative research. The reported prevalence of diagnosed diabetes was 14% with 80% of NHs treating residents with insulin. Hypoglycaemia was reported as 'frequent' in 19% of NHs. A total of 36% of NHs have staff who have received diabetes education or training and 56% have access to diabetes care guidelines. Staff education was the most cited opportunity for improving diabetes care. Focus group and interview findings highlight variations in the level of support provided by GPs and access to dietetic, podiatry and retinal screening services.
  
  
  CONCLUSIONS
  There is a need for national clinical guidelines and standards of care for diabetes management in nursing homes, improved access to quality diabetes education for NH staff, and greater integration between healthcare services and NHs to ensure equity, continuity and quality in diabetes care delivery.
authors.affiliation: Diabetes and Endocrinology Centre, Galway University Hospitals, Health Service Executive, Newcastle Road, Galway, Ireland. Electronic address: Lorna.Hurley@hse.ie.
authors.forename: L
authors.initials: L
authors.lastname: Hurley
authors.affiliation: Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. Electronic address: Maire.odonnell@nuigalway.ie.
authors.forename: M
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. Electronic address: Ronan.ocaoimh@nuigalway.ie.
authors.forename: R
authors.initials: R
authors.lastname: O'Caoimh
authors.affiliation: Diabetes and Endocrinology Centre, Galway University Hospitals, Health Service Executive, Newcastle Road, Galway, Ireland; Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. Electronic address: Sean.dinneen@nuigalway.ie.
authors.forename: S F
authors.initials: SF
authors.lastname: Dinneen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003695:Delivery of Health Care / Q000379:methods*; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D009735:Nursing Homes / Q000592:standards*
keywords: Ageing; Diabetes; Nursing homes; Residential care