Current Diabetes Reports

, 14:464 | Cite as

Diabetes in Long-Term Care Facilities

  • Aaditya Singhal
  • Alissa R. Segal
  • Medha N. Munshi
Hospital Management of Diabetes (G Umpierrez, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hospital Management of Diabetes

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.

Keywords

Older adults Long-term care Diabetes mellitus 

Notes

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.

References

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

  1. 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.CrossRefGoogle Scholar
  2. 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. Google Scholar
  3. 3.
    Munshi M. Managing the “geriatric syndrome” in patients with type 2 diabetes. Consult Pharm. 2008;23(Suppl B):12–6.PubMedGoogle Scholar
  4. 4.
    Holt RM, Schwartz FL, Shubrook JH. Diabetes care in extended-care facilities: appropriate intensity of care? Diabetes Care. 2007;30:1454–8.PubMedCrossRefGoogle Scholar
  5. 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. Google Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in U.S. nursing homes, 2004. Diabetes Care. 2008;31:287–8.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 11.
    Meneilly GS. Diabetes in the elderly. Med Clin N Am. 2006;90:909–23.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 13.
    Zeyda M, Stulnig TM. Obesity, inflammation, and insulin resistance—a mini-review. Gerontology. 2009;55:379–86.PubMedCrossRefGoogle Scholar
  14. 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. 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. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 34.
    American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 37.
    Yki-Jarvinen H. Thiazolidinediones. N Engl J Med. 2004;351:1106–18.PubMedCrossRefGoogle Scholar
  38. 38.
    Meier C, Kraenzlin ME, Bodmer M, et al. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008;168:820–5.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 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.Google Scholar
  41. 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.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Alissa R, Segal P, Munshi MN. Insulin therapy for older adults with diabetes. Geriatr Aging. 2008;11:357–62.Google Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 46.
    American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care. 1998;21:296–309.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Aaditya Singhal
    • 1
  • Alissa R. Segal
    • 2
    • 3
  • Medha N. Munshi
    • 4
    • 2
  1. 1.Beth Israel Deaconess Medical CenterBostonUSA
  2. 2.Joslin Diabetes CenterBostonUSA
  3. 3.MCPHS UniversityBostonUSA
  4. 4.Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA

Personalised recommendations