Diabetes Management Post-Acute and Long-Term Care Setting
Publication Date: November 2, 2015
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
...edge and Skills Needed by Interprofess...
...STEP 1: Is Diabetes...
...oblems and Complications Associated...
...ia for a Diagnosis of Diabetesa...
...ues Indicating Prediabetesa...
Assessment
...STEP 3: Identify Fact...
...STEP 4: Evaluate th...
...roach to Screening for Diabetes-Assoc...
...STEP 5: Identify th...
Treatment
...gure 1. Stepwise Approach to Antihyperglycemic...
...iew of Available Oral Antidiabetic AgentsHavi...
...w of Non-Insulin Injectable Antidiabeti...
...s of Insulin and Their PharmacokineticsHaving...
...tion Recommendations for Adults Wi...
...strongly supports pneumococcal vacc...
...lin Regimens For Different Clinical SituationsHa...
...tions for Adjusting Insulin Therapy on the Bas...
...lin Therapy (basal insulin with rapid acting insu...
...ed Insulin Therapy (regular and NPH, given twic...
...ible Symptoms and Signs of Hypogly...
Monitoring
...e patient with newly diagnosed diabet...
...r attention to the following:
Overall...
...ring of Blood Glucose by Type of Diabetes Ther...
...with risk factors for developing diabetes sh...
...ns and symptoms of hyperglycemia should...
...indicators
Prevalence of hypoglycemic ep...
...rocess indicators
Appropriate...
