Glycemic Over- and Undertreatment in VA Nursing Home Residents with Type 2 Diabetes: a Retrospective Cohort Study
For nursing home (NH) residents, clinical guidelines recommend less stringent hemoglobin A1c (HbA1c) targets between 7.5 and 9.0%1, 2, 3 while avoiding medications with higher hypoglycemia risks such as insulin. Previous studies in community-dwelling older adults have suggested that overly intensive glycemic treatment may be common.4, 5 However, little is known about current glycemic treatment practices among NH residents with type 2 diabetes mellitus (T2DM). Our objective was to determine the rates of glycemic overtreatment (defined as insulin use with HbA1c < 6.5%) and glycemic undertreatment (defined as no glucose-lowering medications with HbA1c ≥ 8.5%) in older adults recently admitted to the NH.
We conducted a retrospective cohort study of Veterans Affairs (VA) nursing home residents over age 65 with T2DM from January 1, 2013, to December 31, 2015. We defined diabetes as HbA1c > 6.5% or use of glucose-lowering medication (GLM) in the year prior to NH...
Compliance with ethical standards
This study was reviewed and approved by the University of California, San Francisco Committee on Human Research.
Conflict of interest
The authors have no conflicts of interest to report
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- 3.Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus. Ann Intern Med. 2017;167(9):655-663. https://doi.org/10.7326/M17-1362.CrossRefPubMedGoogle Scholar