Opportunities Exist for Improving Diabetes Management in LTC: Study
FOR IMMEDIATE RELEASE: June 13, 2023
Contact: Ellen Mullally
Diabetes is common among older adults, including nursing home residents, and there are many challenges to caring for these individuals, including dealing with issues related to multimorbidity, polypharmacy, physical frailty, cognitive impairment, dementia, and physical limitations. A new study in the June issue of JAMDA suggests that there are opportunities for improving diabetes management among nursing home residents.
In Medication Prescribing for Type 2 Diabetes in the U.S. Long-Term Care Setting: An Observational Study, the authors conducted a cross-sectional study using electronic health record databases to characterize prescribing of glucose-lowering medication annually and to quantify the annual frequency of hypoglycemia among residents in long-term care (LTC) facilities with type 2 diabetes mellitus (T2DM). They found that each year from 2016 to 2020, between 68% and 73% of LTC residents with T2DM were prescribed one or more glucose-lowering medications, including oral and injectable agents. Metformin was the most commonly prescribed oral agent, followed by sulfonylureas and dipeptidyl peptidase 4 inhibitors. Basal plus prandial insulin was the most commonly prescribed injectable regimen. Prescribing patterns were relatively consistent from year to year.
The authors also found that 35% of residents with T2DM in their study experienced level 1 hypoglycemia, including up to 12% of those prescribed only oral agents and more than 44% of those taking injectable agents. Approximately a quarter experienced level 2 hypoglycemia.
Medications were counted as “ever-prescribed” and hypoglycemic events as “ever-occurring” during each year in the study. Therefore, the authors said, “We could not establish a temporal relationship or an association, and hypoglycemic events cannot be directly attributed to a specific medication administration.” However, the authors couldn’t determine whether the drugs were utilized as prescribed. Moreover, glucose concentrations, they noted, “were recorded without a fasting status indicator; thus, we could not determine fasting versus non-fasting status.” The researchers also offered the caveat that the database quality depended on the quality of the coding submitted.
This study was conducted by researchers at the College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL; Dickson and Company, Franklin Lakes, NJ; and PointClickCare, Mississauga, Ontario, Canada.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.