Improving Diabetes Management in Long-term Care

By: Valerie Lauer

A quality-improvement initiative in Texas sheds light on strategies for providing enhanced care to patients with diabetes. Improving Diabetes Management in Long-term Care.

Diabetes affects as many as one-third of patients in long-term care; however, due to the wide range of comorbidities and individual medical goals among this population, a single, standard treatment approach is not always the best response.

Addressing the Individual

The need for personalized medication management among elderly patients with diabetes drove Texas A&M University College of Nursing and Health Sciences Assistant Professor Cristi Day, DNP, FNP-C, APRN, ADM-BC, to develop the initiative, implemented at a nursing home in South Texas.
One potentially harmful standardized treatment approach involves sliding scale insulin (SSI). SSI is widely used, but American Geriatrics Society Beers Criteria identify it as an inappropriate treatment option for diabetes in seniors. Long-term monotherapy with SSI is linked to increased risk of hypoglycemia.
“[SSI] is reactive, so you are reacting to what the blood glucose was when you tested,” says Albert Barber, PharmD, CGP, FASCP, Director of Pharmacy Services for AlixaRX, which services patients in long-term- and post-acute-care facilities nationwide. “You have a number that was the result of the previous several hours and are now giving insulin that addresses glucose in the bloodstream over the forthcoming several hours. In a lot of ways, it prevents the nurse or prescriber from really addressing what the core issues are around glucose control.”

Recalibrating Treatment

Day set out to find a better approach………
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Source: MD News