Prevalence, quality of care, and complications in long term care residents with diabetes: A multicenter observational study

Christopher A. Newton, Saira Adeel, Shadi Yarandi, Winter Powell, Alexandra Migdal, Dawn Smiley, Darin Olson, Rakhee Chambria, Ingrid Pinzon, Marcos Toyoshima, Zobair Nagamia, Limin Peng, Theodore Johnson, Guillermo E. Umpierrez

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)842-846
Number of pages5
JournalJournal of the American Medical Directors Association
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

Fingerprint

Quality of Health Care
Long-Term Care
Multicenter Studies
Observational Studies
Hypoglycemia
Hospital Emergency Service
Insulin
Mortality
Hypoglycemic Agents
Length of Stay
Hospitalization
Pharmacology
Infection

Keywords

  • Basal insulin
  • Hospital hyperglycemia
  • Inpatient hyperglycemia
  • Long term care
  • Nursing home
  • Sliding scale insulin

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy

Cite this

Prevalence, quality of care, and complications in long term care residents with diabetes : A multicenter observational study. / Newton, Christopher A.; Adeel, Saira; Yarandi, Shadi; Powell, Winter; Migdal, Alexandra; Smiley, Dawn; Olson, Darin; Chambria, Rakhee; Pinzon, Ingrid; Toyoshima, Marcos; Nagamia, Zobair; Peng, Limin; Johnson, Theodore; Umpierrez, Guillermo E.

In: Journal of the American Medical Directors Association, Vol. 14, No. 11, 01.11.2013, p. 842-846.

Research output: Contribution to journalArticle

Newton, CA, Adeel, S, Yarandi, S, Powell, W, Migdal, A, Smiley, D, Olson, D, Chambria, R, Pinzon, I, Toyoshima, M, Nagamia, Z, Peng, L, Johnson, T & Umpierrez, GE 2013, 'Prevalence, quality of care, and complications in long term care residents with diabetes: A multicenter observational study', Journal of the American Medical Directors Association, vol. 14, no. 11, pp. 842-846. https://doi.org/10.1016/j.jamda.2013.08.001
Newton, Christopher A. ; Adeel, Saira ; Yarandi, Shadi ; Powell, Winter ; Migdal, Alexandra ; Smiley, Dawn ; Olson, Darin ; Chambria, Rakhee ; Pinzon, Ingrid ; Toyoshima, Marcos ; Nagamia, Zobair ; Peng, Limin ; Johnson, Theodore ; Umpierrez, Guillermo E. / Prevalence, quality of care, and complications in long term care residents with diabetes : A multicenter observational study. In: Journal of the American Medical Directors Association. 2013 ; Vol. 14, No. 11. pp. 842-846.
@article{f08e28a34b1c43edac3526e3ae30cda7,
title = "Prevalence, quality of care, and complications in long term care residents with diabetes: A multicenter observational study",
abstract = "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.",
keywords = "Basal insulin, Hospital hyperglycemia, Inpatient hyperglycemia, Long term care, Nursing home, Sliding scale insulin",
author = "Newton, {Christopher A.} and Saira Adeel and Shadi Yarandi and Winter Powell and Alexandra Migdal and Dawn Smiley and Darin Olson and Rakhee Chambria and Ingrid Pinzon and Marcos Toyoshima and Zobair Nagamia and Limin Peng and Theodore Johnson and Umpierrez, {Guillermo E.}",
year = "2013",
month = "11",
day = "1",
doi = "10.1016/j.jamda.2013.08.001",
language = "English (US)",
volume = "14",
pages = "842--846",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",
number = "11",

}

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 - 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.

PY - 2013/11/1

Y1 - 2013/11/1

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

UR - http://www.scopus.com/inward/record.url?scp=84886773448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886773448&partnerID=8YFLogxK

U2 - 10.1016/j.jamda.2013.08.001

DO - 10.1016/j.jamda.2013.08.001

M3 - Article

C2 - 24055534

AN - SCOPUS:84886773448

VL - 14

SP - 842

EP - 846

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 11

ER -