Skip to main content

Advertisement

Log in

Diabetes in Long-Term Care Facilities

  • Hospital Management of Diabetes (G Umpierrez, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

With the aging of the population and longer life expectancies, the prevalence of population with multiple chronic medical conditions has increased. Difficulty managing these conditions as people age (because of changes in physical, functional, or cognitive abilities and the complexity of many treatment regimens), has led to more individuals with multiple medical conditions admitted to the long-term care facilities. Older adults with diabetes residing in the long-term facilities represent the most vulnerable of this cohort. Studies that specifically target diabetes management in older population are lacking and those that target diabetes management in the long-term care facilities are even fewer. The lack of knowledge regarding the care of the elderly residing in long-term care with diabetes may lead to treatment failure and higher risk of hyperglycemia, as well as hypoglycemia. In aging populations, hypoglycemia has the potential for catastrophic consequences. To avoid this, the management of older population with diabetes and other medical comorbidities residing in long-term care facilities requires a more holistic approach compared with focusing on individual chronic disease goal achievement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60:2342–56. This consensus paper delineates available evidence and consideration for issues that may influence treatment decisions in older adults with diabetes.

    Article  Google Scholar 

  2. Association AMD. Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline. In: Columbia, MD: AMDA; 2008; revised 2010. These revised guidelines are the most up-to-date recommendations providing practical guidance for management of diabetes in long-term care settings.

  3. Munshi M. Managing the “geriatric syndrome” in patients with type 2 diabetes. Consult Pharm. 2008;23(Suppl B):12–6.

    PubMed  Google Scholar 

  4. Holt RM, Schwartz FL, Shubrook JH. Diabetes care in extended-care facilities: appropriate intensity of care? Diabetes Care. 2007;30:1454–8.

    Article  PubMed  Google Scholar 

  5. National Diabetes Fact Sheet. General Information and National Estimates on Diabetes in United States. In: U.S. Department of Health and Human Services CDC (ed.) Atlanta, GA; 2011. This data sheet has the current prevalence of diabetes in various age groups and shows the burden of the disease and its complications in the U.S.

  6. Zhang X, Decker FH, Luo H, et al. Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58:724–30.

    Article  PubMed  Google Scholar 

  7. Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in U.S. nursing homes, 2004. Diabetes Care. 2008;31:287–8.

    Article  PubMed  Google Scholar 

  8. Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on diabetes in the elderly and in nursing home residents. J Am Med Dir Assoc. 2011;12:627–32 e2.

    Article  PubMed  Google Scholar 

  9. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46. This article shows the true economical and social impact of diabetes in U.S. It shows the high socioeconomic impact of aging population.

    Article  Google Scholar 

  10. Meneilly GS. The pathophysiology of diabetes in the elderly. In: Medha N, Munshi LAL, editors. Geriatric diabetes. New York: Informa Healthcare; 2007. p. 29–36.

    Chapter  Google Scholar 

  11. Meneilly GS. Diabetes in the elderly. Med Clin N Am. 2006;90:909–23.

    Article  PubMed  Google Scholar 

  12. Elahi D, Muller DC, Egan JM, et al. Glucose tolerance, glucose utilization and insulin secretion in ageing. Novartis Found Symp. 2002;242:222–42. discussion 242–6.

    Article  CAS  PubMed  Google Scholar 

  13. Zeyda M, Stulnig TM. Obesity, inflammation, and insulin resistance—a mini-review. Gerontology. 2009;55:379–86.

    Article  CAS  PubMed  Google Scholar 

  14. Blaum C. Diabetes mellitus. In: Durso S, Sullivan GM, editors. Geriatric review syllabus: a core curriculum in geriatric medicine. 8th ed. New York: American Geriatric Society; 2013. p. 566–75.

    Google Scholar 

  15. Meneilly GS. Diabetes. In: Evans J, Williams TF, Beattie BL, editors. Textbook of geriatric medicine. 2nd ed. Oxford: Oxford University Press; 2000. p. 210–7.

    Google Scholar 

  16. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.

    Article  CAS  PubMed  Google Scholar 

  17. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.

    Article  CAS  PubMed  Google Scholar 

  18. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.

    Article  CAS  PubMed  Google Scholar 

  19. Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009;32:187–92.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bremer JP, Jauch-Chara K, Hallschmid M, et al. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32:1513–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Matyka K, Evans M, Lomas J, et al. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care. 1997;20:135–41.

    Article  CAS  PubMed  Google Scholar 

  22. Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multi-center observational study. J Am Med Dir Assoc. 2013;14(11):842–6.

    Article  PubMed  Google Scholar 

  23. Denardo SJ, Gong Y, Nichols WW, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med. 2010;123:719–26.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Zhao W, Katzmarzyk PT, Horswell R, et al. Aggressive blood pressure control increases coronary heart disease risk among diabetic patients. Diabetes Care. 2013;36(10):3287–96. This prospective cohort study contributes to understanding of level of BP control in patients with coronary heart disease and diabetes. The study shows a "U" shaped associated between BP and risk of CHD suggesting that aggressive BP cotnrol is associated with increase risk of CHD in patients with diabetes.

    Article  PubMed  Google Scholar 

  25. Sinclair A, Morley JE, Rodriguez-Manas L, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology. and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc. 2012;13:497–502.

    Article  PubMed  Google Scholar 

  26. Sinclair AJ, Paolisso G, Castro M, et al. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011;37 Suppl 3:S27–38. This positions statement delineates guidelines and opinons by an international panel of experts.

    Article  PubMed  Google Scholar 

  27. Roussel R, Travert F, Pasquet B, et al. Metformin use and mortality among patients with diabetes and atherothrombosis. Arch Intern Med. 2010;170:1892–9.

    Article  CAS  PubMed  Google Scholar 

  28. Lee CG, Boyko EJ, Barrett-Connor E, et al. Insulin sensitizers may attenuate lean mass loss in older men with diabetes. Diabetes Care. 2011;34:2381–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care. 2011;34:1431–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: systematic review and meta-analysis. JAMA. 2007;298:194–206.

    Article  CAS  PubMed  Google Scholar 

  31. Pratley RE, Rosenstock J, Pi-Sunyer FX, et al. Management of type 2 diabetes in treatment-naive elderly patients: benefits and risks of vildagliptin monotherapy. Diabetes Care. 2007;30:3017–22.

    Article  CAS  PubMed  Google Scholar 

  32. Karyekar CS, Ravichandran S, Allen E, et al. Tolerability and efficacy of glycemic control with saxagliptin in older patients (aged ≥65 years) with inadequately controlled type 2 diabetes mellitus. Clin Interv Aging. 2013;8:419–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  34. American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

    Article  Google Scholar 

  35. van de Laar FA, Lucassen PL, Akkermans RP, et al. Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diabetes Care. 2005;28:154–63.

    Article  PubMed  Google Scholar 

  36. Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.

    Article  CAS  PubMed  Google Scholar 

  37. Yki-Jarvinen H. Thiazolidinediones. N Engl J Med. 2004;351:1106–18.

    Article  PubMed  Google Scholar 

  38. Meier C, Kraenzlin ME, Bodmer M, et al. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008;168:820–5.

    Article  CAS  PubMed  Google Scholar 

  39. Colmers IN, Bowker SL, Majumdar SR, Johnson JA. Use of thiazolidinediones and the risk of bladder cancer among people with type 2 diabetes: a meta-analysis. CMAJ. 2012;184:E675–83.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Bode B, Sinclair A, Harris S, Vijapurkar U, Mayer C, Fung A, et al. Efficacy and safety of canagliflozin in older subjects with type 2 diabetes. In: The 73rd scientific sessions of the American Diabetes Association. Chicago, IL: Diabetes. 2013; p. LB-76.

  41. Munshi MN, Pandya N, Umpierrez GE, et al. Contributions of basal and prandial hyperglycemia to total hyperglycemia in older and younger adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2013;61:535–41. This meta-analysis provides important information about differences in hyperglycemia patterns in old vs young patients. This information can be used to target hyperglycemia differently in older patients and avoid treatment induced hypoglycemia.

    Article  PubMed  Google Scholar 

  42. Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361:1736–47.

    Article  CAS  PubMed  Google Scholar 

  43. Karnieli E, Baeres FM, Dzida G, et al. Observational study of once-daily insulin detemir in people with type 2 diabetes aged 75 years or older: a sub-analysis of data from the Study of Once daily LeVEmir (SOLVE). Drugs Aging. 2013;30:167–75.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Alissa R, Segal P, Munshi MN. Insulin therapy for older adults with diabetes. Geriatr Aging. 2008;11:357–62.

    Google Scholar 

  45. Pandya N, Nathanson E. Managing diabetes in long-term care facilities: benefits of switching from human insulin to insulin analogs. J Am Med Dir Assoc. 2010;11:171–8.

    Article  PubMed  Google Scholar 

  46. American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care. 1998;21:296–309.

    Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Aaditya Singhal declares that she has no conflict of interest. Alissa R. Segal declares that she has no conflict of interest. Medha N. Munshi has received a research grant from Sanofi.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Medha N. Munshi.

Additional information

This article is part of the Topical Collection on Hospital Management of Diabetes

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singhal, A., Segal, A.R. & Munshi, M.N. Diabetes in Long-Term Care Facilities. Curr Diab Rep 14, 464 (2014). https://doi.org/10.1007/s11892-013-0464-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-013-0464-y

Keywords

Navigation