Hypoglycemia, can be a side effect of treatment with blood sugar lowering medications such as sulfonylureas, like Glipizide and insulin. These hypoglycemic events are considered adverse drug events. Each year, 35 percent of LTC residents with type 2 diabetes experience hypoglycemia. Researchers found that 68-73 percent of residents were prescribed one or more glucose-lowering medications.
Metformin topped the list as the most prescribed oral agent, followed by sulfonylureas. Residents who were prescribed high-risk medications and sliding scale insulin regimens were most likely to experience hypoglycemia.
“Reviewing medications of those residents at high risk of harms and with low likelihood of benefit from intensive diabetes treatment might be a good idea. Maybe look at those residents with a history of hypoglycemia or high levels of cognitive or functional impairment. I think sometimes we forget that hypoglycemia when a person receives diabetes medicine is an adverse drug event. We should be reviewing these in our quality improvement process meetings and ensuring these harms are not occurring in our homes to ensure resident safety,” shared Tammy Wagner, RN, CADDCT, CDP, LSSGB; Quality Improvement Advisor with Great Plains Quality Innovation Network.
Opportunities exist for improving clinical management of diabetes among LTC residents with type 2 diabetes. Use one or more of these tools to help you with reducing hypoglycemic adverse drug events:
- Adverse Drug Event Trigger Tool
- ODPHP National Action Plan for ADE Prevention Diabetes Agents
- Adverse Events in Nursing Homes
- All Cause Harm Prevention in Nursing Homes Change Package
- IHI SNF Trigger Tool for Measuring Adverse Events
- Post-Acute & Long-Term Care Quality Prescribing
“As a certified diabetes care and education specialist (CDCES), I know the complications that can arise from prolonged elevated blood sugars, but on the other hand, I have seen the effects low blood sugars or hypoglycemia can have on a person, especially on the elderly. One of the biggest concerns is a person falling when blood sugars are low and the injuries that result from the fall, which usually decreases the person’s independence. I’m a huge advocate of de-prescribing high-risk diabetes medications and sliding scale insulin regimens that have the potential to cause hypoglycemia. There are many alternatives to use in place of these high-risk diabetes medications that don’t have the hypoglycemia risk. Providers need to consider what is appropriate for each resident in a LTCF so they can maintain quality of life,” added Dee Kaser, RN, CDCES; Quality Improvement Advisor with Great Plains Quality Innovation Network.
Access the study in JAMDA, The Society for Post-Acute and Long-Term Care Medicine.