ADA Addresses Diabetes Management in Long-Term Care Facilities

Simplified diabetes management protocols are also emphasized. They are better tolerated, and in LTC facilities, which often operate without a full-time practitioner to supervise care, they are preferred over more complicated protocols.1

Additionally, the ADA recommends that care be taken when transferring patients from one facility, setting, or provider to another. Transfer documents should include the patient’s current meal plan, activity level, prior treatment regimen, self-care education, lab results (including HbA1c, lipid levels, and renal function), fluid status, and notes on previous hypoglycemic episodes.1 

“A novel element of the statement is its address of supportive and end-of-life care for patients with diabetes who may be receiving palliative or hospice care,” explained Dr Florez. Such care entails “relaxed glycemic targets, simplified regimens, and respecting the patient’s right to refuse treatment and seek comfort care,” he said.

According to the ADA statement, end-of-life goals should focus on providing comfort and avoiding distressing conditions, including pain, dehydration, and blood glucose extremes, as well as ER visits and hospitalization.1   

Practical Implementation

Speaking for the American Association of Clinical Endocrinologists, Alan J. Garber, MD, PhD, FACE, professor of medicine, biochemistry, molecular and cellular biology at Baylor College of Medicine in Houston, commented that the ADA statement attempts to define best practices.

“The avoidance of hypoglycemia while maintaining some sort of reasonable blood sugar control is the fine balance you’re trying to achieve for elderly patients,” he told Endocrinology Advisor. The ADA statement provides strategies for achieving that balance. 

Dr Florez expects that health care professionals will welcome the practical guidelines for diabetes management, which take into account “how LTC facilities function.” The intended audience for the statement includes endocrinologists, geriatricians, and primary care practitioners, especially those who manage older patients with diabetes in LTC settings. The position statement will be disseminated at the national and regional levels, with the support of the ADA and other professional organizations, explained Dr Florez. He expects that the recommendations will be incorporated into future geriatrics and endocrinology curricula for medical students and other health care trainees.

In the United States, type 2 diabetes disproportionately affects the elderly, and the percentage of patients with diabetes in long-term care may be as high as 34%.4 As the number of older adults with diabetes is expected to increase, Dr Florez noted, “we need to strategically chart a patient-centered approach for this highly vulnerable population, providing clear guidelines with individualized goals to preserve their quality of life and reduce suffering.”

References

  1. Munshi MN, Florez H, Huang ES, et al. Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(2):308-318. doi:10.2337/dc15-2512./li>
  2. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002-2012. doi:10.1056/NEJMsa1103053.
  3. Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multicenter observational study. J Am Med Dir Assoc. 2013;14(11):842-846. doi:10.1016/j.jamda.2013.08.001.
  4. Dorner B, Friedrich EK, Posthauer ME. Position of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. J Am Diet Assoc. 2010;110(10):1549-53. doi:10.1016/j.jada.2010.08.022.