TY - JOUR
T1 - Prevalence, quality of care, and complications in long term care residents with diabetes
T2 - A multicenter observational study
AU - Newton, Christopher A.
AU - Adeel, Saira
AU - Sadeghi-Yarandi, Shadi
AU - Powell, Winter
AU - Migdal, Alexandra
AU - Smiley, Dawn
AU - Olson, Darin
AU - Chambria, Rakhee
AU - Pinzon, Ingrid
AU - Toyoshima, Marcos
AU - Nagamia, Zobair
AU - Peng, Limin
AU - Johnson, Theodore
AU - Umpierrez, Guillermo E.
N1 - Funding Information:
This investigator-initiated study was supported by an unrestricted grant from Sanofi Aventis (Bridgewater, NJ).
PY - 2013/11
Y1 - 2013/11
N2 - 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. Conclusion: 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.
AB - 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. Conclusion: 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.
KW - Basal insulin
KW - Hospital hyperglycemia
KW - Inpatient hyperglycemia
KW - Long term care
KW - Nursing home
KW - Sliding scale insulin
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U2 - 10.1016/j.jamda.2013.08.001
DO - 10.1016/j.jamda.2013.08.001
M3 - Article
C2 - 24055534
AN - SCOPUS:84886773448
SN - 1525-8610
VL - 14
SP - 842
EP - 846
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 11
ER -