Journal of the American Medical Directors Association
Clinical Practice in Long Term CarePrevalence, Quality of Care, and Complications in Long Term Care Residents With Diabetes: A Multicenter Observational Study
Section snippets
Methods
Medical records from patients admitted to 3 academic urban LTC facilities affiliated with Emory University (Budd Terrace, A.G. Rhodes, and Veterans Administration) between January 1, 2008, and December 31, 2008, were included in the analysis. We included patients with a direct primary admission and those who were transferred from the hospital for subacute rehabilitation and for LTC. We excluded patients with a length of stay less than 24 hours. The Emory University Institutional Board Review
Patient Population
Clinical characteristics of study patients are shown in Table 1. The patient population included 1409 patients, 59% female with a mean age of 79.7 ± 12.0 years, and a mean body mass index (BMI) of 25.7 ± 7.0 kg/m2. A diagnosis of diabetes on admission was recorded in 482 cases (34.2%); of them, 10 patients (2.1%) had type 1 diabetes and 472 (97.9%) had type 2 diabetes. Compared with patients without diabetes, patients with diabetes were younger, had higher BMI, and had a higher percentage of
Discussion
This study analyzed the prevalence and management of diabetes, as well as the impact of glycemic control, on clinical outcome in elderly subjects admitted to LTC facilities. Our results indicate that one-third of LTC residents had a diagnosis of diabetes. In agreement with previous studies, we found that patients with diabetes had higher rates of medical comorbidities on admission, and experienced a higher number of complications during the study period compared with those without diabetes. SSI
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2023, Journal of the American Medical Directors AssociationPotential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review
2021, Journal of the American Medical Directors AssociationCitation Excerpt :In a study involving people aged ≥75 years, rates of overtreatment (defined as individuals treated with insulin and/or sulfonylureas while having HbA1c <7.0% and high hypoglycemia risks; ie, having renal impairment or cognitive dysfunction) were 10.1% for individuals with HbA1c <6.0%, 25.2% for HbA1c <6.5%, and 44.3% for HbA1c <7.0%.57 Our review also revealed a high prevalence [median 38% (IQR 24%–56%)] of SSI use in 3 studies (data collected 2008–2012),37,44,45 with 1 study reporting that residents receiving SSI contributed to half of the major and half of the minor hypoglycemic episodes (data collected 2012).45 Prevalence of SSI use captured by this review is consistent with previous LTCF study findings (73.8%, n = 2096).58
Management of Inpatient Hyperglycemia and Diabetes in Older Adults
2020, Clinics in Geriatric MedicineCitation Excerpt :Establishing an independent causal relationship between hypoglycemia and mortality among elderly individuals with multiple comorbidities is complex in observational studies. Clinical trials in non–intensive care unit (ICU) settings have reported an incidence of hypoglycemia of approximately 12% to 38% for patients with type 2 diabetes receiving insulin therapy.7,64,65,81–83 These trials, however, have reported a very low incidence of severe hypoglycemia in a controlled setting and have not been powered to assess mortality.
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This investigator-initiated study was supported by an unrestricted grant from Sanofi Aventis (Bridgewater, NJ).
CAN, SA, SS-Y, WP, AM, DS, DO, RC, IP, MT, ZN, LP, and TJ reviewed/edited the research proposal and manuscript and contributed to the discussion. SS-Y, WP, AM, RC, and IP collected the research data. LP performed the statistical analyses.
GEU is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
GEU is supported in part by research grants from the American Diabetes Association (7–03-CR-35), and Public Health Service Grant UL1 RR025008 from the Clinical and Translational Science Award Program (M01 RR-00039), National Institutes of Health, National Center for Research Resources.
All other authors who contributed to this manuscript have no conflicts of interest to declare.