Good clinical practice guidelines for care home residents with diabetes: an executive summary

Abstract

A Task and Finish Group of Diabetes UK was convened over 14 months to undertake a systematic review of the original 1999 British Diabetic Association guidance on care home diabetes, incorporate new research findings and produce a set of recommendations that are evidenced-based, practical and implementable within UK care home settings. The anticipation of Diabetes UK is that these guidelines will represent a national policy of good clinical practice for diabetes care within care homes. This executive summary demonstrates how the full guidelines should provide a framework of assessment of the quality of diabetes care within care homes, for use by regulatory bodies who have responsibility for this provision of diabetes care. This document is primarily based on recommendations for adults living within British care home environments and its focus, by virtue of the nature and characteristics of residents, is on older adults. Improvements in diabetes care within residential and nursing homes are likely to follow a sustained commitment by health and social care professionals to ensure that the well-being of residents with diabetes is paramount, that high-quality policies of diabetes care are implemented and monitored and effective diabetes education is a mandatory and integral part of care home staff training.Diabet. Med. 28, 772-777 (2011)

Severe Hypoglycemia Is Associated With Antidiabetic Oral Treatment Compared With Insulin Analogs in Nursing Home Patients With Type 2 Diabetes and Dementia: Results From the DIMORA Study

“…At the moment, current international guidelines have provided recommendations to avoid severe hypoglycemia in older patients in nursing homes. 10 To reach these goals, these guidelines have recommended obtaining a more elastic glycemic control (range of HbA1c: 7%e8%) in older frail nursing home patients 7e10 ; however, the guidelines do not provide antidiabetic treatment algorithms for those with dementia. Indeed, whether specific antidiabetic treatment regimens can maintain a "safe" glycemic control to avoid hypoglycemia, especially in older patients with dementia, has not been investigated.…”

Diabetes, Nutrition, and Exercise

“…54 The proposed MID-Frail study will evaluate the clinical, functional, social, and economic impacts of a multimodal intervention (resistance training exercise, diet, and education) in frail and prefrail subjects aged greater than or equal to 70 years with type 2 diabetes compared with usual clinical practice. 55 The imposition of carbohydrate restrictions on frail older people with diabetes, especially those living in care homes, is not warranted. Malnutrition and dehydration may develop because of unnecessary restrictions.…”

Limited Effectiveness of Diabetes Risk Assessment Tools in Seniors’ Facility Residents

“…The CANRISK groups respondents into three risk categories: low (scores 0-20), moderate (scores 21-32), and high (scores 33-91) [26]. The Canadian Task Force also groups respondents to the FINDRISC survey into three risk categories: low to moderate (scores 0-15), high (scores [16][17][18][19][20], and very high (scores 21-26) [26,34].…”

“…Furthermore, the economic burden associated with a case of undetected diabetes is estimated to be 8 times that of a person with prediabetes [16]. Concern regarding undetected diabetes in seniors is illustrated in guidelines and position statements from Australia, the United States, the United Kingdom, and the International Diabetes Federation that recommend screening for diabetes on admission to care homes [17][18][19][20].…”