How well are we managing diabetes in long-term care?

Purpose Our objective was to compare the management of diabetes mellitus (DM) in residents of extended-care facilities with the American Diabetes Association (ADA) standards of care for ambulatory adults. Methods We reviewed the charts of 245 residents in 14 extended-care facilities. All had a physician-documented diagnosis of type 1 or type 2 DM and had spent at least 3 of the past 12 months in the facility. We reviewed medical diagnoses, medications, laboratory reports, and consultation notes of one-year duration, then compared our findings with the ADA standards of care. Results Of the 245 patients, 211 (86.1%) had their glucose monitored; 36.7% had a hemoglobin A1c (A1c) below 7%. Fifty-two residents (21.2%) experienced hypoglycemic events; 103 (42%) had hyperglycemic events. Of the 240 patients (98%) whose blood pressure (BP) was monitored, 107 (43.7%) met the ADA goal. Lipids were checked in 190 residents (77.6%), 89 (46.8%) of whom met the goal for low-density lipoprotein (LDL). Dilated eye examinations were provided to 133 patients (54.3%). Foot examinations were performed on 187 residents (76.3%); 170 (69.4%) had a consultation with a podiatrist. Conclusions Our chart review demonstrates that the management of diabetes in extended-care facilities does not meet the recommended ADA standards of care for ambulatory adults. Although 36.7% of patients met the A1c goal, the A1c did not account for glucose variability. Only 46.8% of patients met the recommended LDL goal. Our results suggest the need for new standards of care for patients with diabetes residing in nursing facilities. These standards should take into account the particular needs of this patient population, specifically with regard to hypoglycemic risk, cardiovascular risk factors, and quality of life.