New American Diabetes Association (ADA) guidelines addressing diabetes management in long-term care and skilled nursing facilities emphasize treatment simplification, avoidance of hypoglycemia and the need to reassess therapeutic goals for patients who are nearing the end of life.
The guidelines were published in the February issue of Diabetes Care by Medha N Munshi, MD, director of the Joslin Geriatric Diabetes Program, Boston, Massachusetts and colleagues.
“Previous statements from the ADA have addressed care for the elderly in community settings and diabetes care among hospitalized patients, but this is the first to specifically address the unique needs of patients in long-term care settings, where the approach to diabetes management often needs to be dramatically altered from those in younger and healthier patients”, Dr Munshi told Medscape Medical News. Dr. Munshi and her colleagues also point out that the vast majority of patients with diabetes in long-term care facilities have type 2 diabetes, so most recommendations in this position statement are directed toward that population.
The guidelines are aimed at a variety of audiences and provide information about the special considerations in institutionalized elderly patients, including guidance on the assessment of functional capacity and common co-morbidities that may interfere with care. The guidelines also include strategies for simplifying treatment regimens as well as detailed diabetes-specific information and guidance, including minimization of hypoglycemia by replacing sliding-scale insulin-dosing regimens and a medication roundup.
The document also provides recommendations for transitions of care, advising that those times are particularly important for revisiting management goals and providing patient and caregiver education. And for patients nearing the end of life, the guidelines advise respecting patients’ wishes regarding the right to refuse treatment. At that phase, Dr Munshi advised, “Patients need to have whatever makes them comfortable.”
Source: doi: 10.2337/dc15-2512 Diabetes Care February 2016 vol. 39 no. 2 308-318