Management Of Diabetes In The Long Term Care Population

The economic, social and health burden of diabetes is significant, especially in the elderly population. This is a common disease that affects more than 20% of adults aged 65 to 75 years and 40% of adults older than 80 years. The prevalence of diabetes in long-term care (LTC) facilities is similar to that in the general population, but may be underestimated. Previous studies indicated that in a Canadian long-term care facility, a screening program reclassified a third of residents as having diabetes during a three-year period. Management of diabetes in LTC facilities is challenging due to the under-resourced environment and the nature of this specific population (e.g. age, higher rates of premature death, functional disability, and more co-morbidities than non-diabetics). Besides lifestyle modification and pharmacological therapy, blood glucose monitoring (levels of blood glucose or HbA1c) is also essential to ensure satisfactory glycemic control. Due to the metabolic differences of diabetes in the elderly compared with younger patients, the approaches of disease management should be different. The burden of rigourous near normal glycemic control (e.g. cost of patient discomfort) may outweigh the benefits (such as preventing long-term complications) in this population. Previous clinical practice guidelines have suggested that the glycemic target should be individualized based on the patient's functional status: patients with good functional status should be maintained at HbA1c lower than 7%, whereas those who are frail (have multiple co-morbidities, increased risk of hypoglycemia or have a life expectancy of fewer than 5 years) should be maintained at a less stringent target of lower than 8%. CADTH published a report in 2010 for the purpose of summarizing guideline recommendations regarding the management of diabetes in a long-term care population, but limited evidence was found. The purpose of this review is to identify any evidence and recommendations noted in the evidence-based guidelines for blood glucose monitoring in diabetic patients in LTC setting.