The American Diabetes Association recently issued a statement entitled “Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association,” published in the journal Diabetes Care, recommending guidelines for long-term facilities to manage adults over age 65 with type 2 diabetes.
Diabetes is increasingly more common in individuals over 65 years old, and is expected to continue increasing as the U.S. population ages, with patients requiring long-term care facilities. Establishing a group of guidelines so that patients receive proper care is the goal of the recent American Diabetes Association’s statement with authors focusing on assisted living, skilled nursing, and care facilities.
“The differences in caring for older people with type 2 diabetes aren’t well understood and haven’t been the focus of guidelines for managing the disease. We wanted to give long-term care facilities very clear guidelines for caring for patients with diabetes that they can adapt into their care protocols,” the statement’s lead author, Medha N. Munshi, MD, director of the Joslin Diabetes Center Geriatric Diabetes Program and assistant professor at Harvard Medical School, said in a press release.
Since there is high heterogeneity on this population with regard to comorbidities and overall health status, “Care of older patients with diabetes needs to be patient-centered and focused on individualized goals,” Munshi said. The team highlighted the critical points that should be given particular attention:
- Hypoglycemia: Older patients are more prone to hypoglycemia, so simplified treatment regimens are preferred and other forms of control, specifically the sole use of sliding scale insulin (SSI, the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges) should be avoided, since it is associated with wide variations in blood glucose levels and requires increasing assistance and resources;
- Increasing food choices is preferable to therapeutic diets, since food variety benefits nutritional needs and glycemic control.
Additionally, since patients often transit between healthcare facilities, which increases the risk for adverse events, to ameliorate and prevent this risk, authors emphasized the need for continuous communication among healthcare providers and to accompany transitions with the supporting documentation.
End-of-life care for diabetes patients is still an issue under consideration, but for now, the American Diabetes Association recommends relaxing glycemic targets, simplifying regimens, and respecting patients’ wishes for refusing diabetes treatment.
“It is also important to educate endocrinologists, who may not have experience with long-term care facilities, and geriatricians, who may lack a comprehensive understanding of diabetes care,” Munshi said.