Clinical Practice in Long Term Care
Prevalence, Quality of Care, and Complications in Long Term Care Residents With Diabetes: A Multicenter Observational Study

https://doi.org/10.1016/j.jamda.2013.08.001Get rights and content

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.

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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    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.

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