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
...Skills Needed by Interprofessional Team...
...1: Is Diabetes Present?...
...ems and Complications Associated With Dia...
...a Diagnosis of Diabetesa...
...alues Indicating Prediabetesa...
...: Screen for Possible Diabetes in Patients With...
Assessment
STEP 3: Identify Factors Contributing to the Pat...
...ate the Nature and Severity of Diabetic Complicat...
Suggested Approach to Screening for Dia...
...tify the Impact of Diabetes on the Pa...
Treatment
...p an Individualized Care Plan and Defi...
...TEP 7: Implement the Care Plan ...
Figure 1. Stepwise Approach to Antihyperglycemi...
...ailable Oral Antidiabetic AgentsHaving...
...n-Insulin Injectable Antidiabetic AgentsHavi...
...sulin and Their PharmacokineticsHavin...
...ization Recommendations for Adults...
...trongly supports pneumococcal vaccination consist...
...ed Insulin Regimens For Different Clinical Situa...
...r Adjusting Insulin Therapy on the Bas...
...n Therapy (basal insulin with rapid acti...
Combined Insulin Therapy (regular and NPH, gi...
...ptoms and Signs of Hypoglycemia in Frail...
Monitoring
...luate the Patient Periodically...
...the patient with newly diagnosed d...
...ar attention to the following:
Overall...
...TEP 9: Monitor the Patient’s Blood Glucose Leve...
...itoring of Blood Glucose by Type of Diabetes The...
STEP 10: Individualize Diabetes and Manageme...
...ients with risk factors for developing diabe...
...th signs and symptoms of hyperglycemia...
...1: Monitor the Facility's Management...
...tors
Prevalence of hypoglycemic episo...
...ors Appropriate recognition and diagno...
