Management of diabetes in longterm care and skilled nursing facilities

A position statement of the American diabetes association

Medha N. Munshi, Hermes J Florez, Elbert S. Huang, Rita R. Kalyani, Maria Mupanomunda, Naushira Pandya, Carrie S. Swift, Tracey H. Taveira, Linda B. Haas

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.

Original languageEnglish (US)
Pages (from-to)308-318
Number of pages11
JournalDiabetes Care
Volume39
Issue number2
DOIs
StatePublished - Feb 1 2016

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Skilled Nursing Facilities
Long-Term Care
Hypoglycemia
Comorbidity
Insulin
Population
Hospice Care
Patient Transfer
Population Characteristics
Administrative Personnel
Palliative Care
Health Status
Quality of Life
Costs and Cost Analysis
Glucose
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Management of diabetes in longterm care and skilled nursing facilities : A position statement of the American diabetes association. / Munshi, Medha N.; Florez, Hermes J; Huang, Elbert S.; Kalyani, Rita R.; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S.; Taveira, Tracey H.; Haas, Linda B.

In: Diabetes Care, Vol. 39, No. 2, 01.02.2016, p. 308-318.

Research output: Contribution to journalArticle

Munshi, MN, Florez, HJ, Huang, ES, Kalyani, RR, Mupanomunda, M, Pandya, N, Swift, CS, Taveira, TH & Haas, LB 2016, 'Management of diabetes in longterm care and skilled nursing facilities: A position statement of the American diabetes association', Diabetes Care, vol. 39, no. 2, pp. 308-318. https://doi.org/10.2337/dc15-2512
Munshi, Medha N. ; Florez, Hermes J ; Huang, Elbert S. ; Kalyani, Rita R. ; Mupanomunda, Maria ; Pandya, Naushira ; Swift, Carrie S. ; Taveira, Tracey H. ; Haas, Linda B. / Management of diabetes in longterm care and skilled nursing facilities : A position statement of the American diabetes association. In: Diabetes Care. 2016 ; Vol. 39, No. 2. pp. 308-318.
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