Diabetes Management Post-Acute and Long-Term Care Setting
Publication Date: October 11, 2024
Key Points
Key Points
- Multimorbidity, functional impairments, and psychosocial issues increases the complexity of diabetes management in the PA/LTC.
- Cardiovascular mortality, functional impairment and cognitive decline increase with hyperglycemia.
- Hypoglycemia (frequent or prolonged) can cause cognitive impairment, falls and functional impairment. Prolonged or frequent hypoglycemia can affect cognition and increase the chance of falls, seizures and stroke.
- Cardiovascular mortality, cognitive decline, falls and functional impairment are increased in older adults with DM.
General
The management of patients with diabetes in the PA-LTC setting should be individualized and guided by functional and cognitive status, patient preference, and life expectancy ( Strong , Low )
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The medication regimen for diabetes should be verified and communicated to receiving practitioners if the patient is transferred to another site of care ( Strong , Low )
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Recognition
Patients in the PA-LTC setting should be screened for diabetes or pre-diabetes unless they are terminally ill. ( Strong , Moderate )
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Factors causing or exacerbating hyperglycemia should be sought. ( Strong , Low )
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Assessment
Patients with diabetes should be evaluated for the presence of macrovascular and microvascular complications. ( Strong , High )
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Patients with diabetes should be assessed for the presence of cognitive impairment. ( Weak , Low )
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Patients with diabetes should be assessed for the presence of depression. ( Strong , High )
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Patients with diabetes should be assessed for the presence of foot complications. ( Strong , Moderate )
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Treatment/Management
In general, patients with diabetes should be offered a regular diet. ( Strong , Low )
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In general, metformin is preferred as an initial oral medication for the treatment of diabetes in the absence of absolute or relative contraindications. ( Strong , Low )
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If treatment with insulin is required, basal insulin is the preferred initial choice if its use can achieve glycemic targets. ( Strong , Low )
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The use of sliding-scale insulin alone to control blood glucose levels should be avoided. ( Strong , Moderate )
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It is reasonable to aim for A1C targets between 7.5% and 8.5% for most patients, although higher targets may be appropriate for certain individuals. ( Strong , Moderate )
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A blood-pressure goal of less than 150/90 is recommended for most older patients with diabetes. ( Strong , High )
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Statin therapy is recommended for all older patients with diabetes who are able to tolerate it and who lack contraindications. ( Strong , High )
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Monitoring
Blood glucose patterns should be reviewed regularly to allow logical adjustment of the pharmacological regimen. ( Strong , Low )
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Patients being treated for diabetes should be monitored for the occurrence of hypoglycemia and the treatment regimen adjusted as necessary. ( Strong , Moderate )
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The facility should monitor its management of patients with diabetes by measuring and tracking selected relevant process and outcome indicators. ( Strong , Moderate )
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Recognition
...ledge and Skills Needed by Interpr...
...roblems and Complications Associated With Diabet...
...Diagnosis of Diabetesa...
Laboratory Values Indicating Prediab...
...Screen for Possible Diabetes in Patients Wit...
Assessment
...dentify Factors Contributing to the Pat...
...e the Nature and Severity of Diabeti...
...sted Approach to Screening for Diabetes-Associ...
...dentify the Impact of Diabetes on the...
Treatment
...: Develop an Individualized Care Plan...
...gure 1. Stepwise Approach to Antihype...
...ew of Available Oral Antidiabetic AgentsH...
...of Non-Insulin Injectable Antidiabetic Agent...
...lin and Their PharmacokineticsHaving trouble v...
...ommendations for Adults With DiabetesHaving...
...ety strongly supports pneumococcal vaccinat...
...ested Insulin Regimens For Different...
Suggestions for Adjusting Insulin Therapy on the...
...nalog Insulin Therapy (basal insulin w...
...bined Insulin Therapy (regular an...
...s and Signs of Hypoglycemia in Frail Elderly Pat...
Monitoring
STEP 8: Re-evaluate the Patient P...
...ss the patient with newly diagnosed di...
...attention to the following:
Overall medical...
...nitor the Patient’s Blood Glucose Levels...
...d Monitoring of Blood Glucose by T...
...ndividualize Diabetes and Managemen...
...s with risk factors for developing diabetes...
...with signs and symptoms of hyperglycemia...
STEP 11: Monitor the Facility's...
...come indicators
Prevalence of...
...rocess indicators Appropriate recognition...
