Table 1

Challenges facing diabetes management at long-term care facility from American Diabetes Association guidelines50 128

Patient relatedFacility relatedDiabetes management related
Irregular eating habitsStaff turnoverSole use of sliding scale insulin
Altered cognition, anxiety and depressionLack of nutritional individualizationMismatch insulin administration timing in relation to feeding time
Impaired mobilityLack of or insufficient glucose monitoringInappropriate hypoglycemia management
Polypharmacy and medication reconciliation errorsLimited staff diabetes-specific knowledge and trainingLimited knowledge of advanced technologies (continuous glucose monitoring)
Variable levels of social supportLack of pharmacist and dietitian supportLack of comprehensive transitional diabetes management protocol
Variable nutritional needsLack of comprehensive notification systemLack of diabetes management protocols
Persistent pain
Oral health, skin and vision problems