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

Recognition

...and Skills Needed by Interprofessional...


...P 1: Is Diabetes Present?...

...lems and Complications Associated With Diabetes in...

...a for a Diagnosis of Diabetesa...

...oratory Values Indicating Prediabete...


...EP 2: Screen for Possible Diabetes...


Assessment

...sessmen...

...TEP 3: Identify Factors Contributing t...


...P 4: Evaluate the Nature and Severity...

...uggested Approach to Screening for Diabetes-As...


...dentify the Impact of Diabetes on the Pat...


Treatment

...reatment

...EP 6: Develop an Individualized Care Plan an...


STEP 7: Implement the Care Plan ...

...Use Insulin...


...wise Approach to Antihyperglycemic TherapyHavin...


...of Available Oral Antidiabetic Agents...


...verview of Non-Insulin Injectable Antidiabetic A...


...of Insulin and Their Pharmacokinetic...


...unization Recommendations for Adults With...


...Society strongly supports pneumococcal vaccinatio...


...ed Insulin Regimens For Different...


Suggestions for Adjusting Insulin Therap...


...alog Insulin Therapy (basal insulin with rapid...


...ined Insulin Therapy (regular and NPH, given t...


...ible Symptoms and Signs of Hypoglycemia...


Monitoring

...itoring...

...-evaluate the Patient Periodically...

...patient with newly diagnosed diabetes when medic...

...particular attention to the following:...


...tor the Patient’s Blood Glucose Level...

...ed Monitoring of Blood Glucose by Type of Diabete...


...Individualize Diabetes and Managem...

...th risk factors for developing diabetes should be...

...igns and symptoms of hyperglycemia sho...


...11: Monitor the Facility's Management of...

...indicators Prevalence of hypoglycem...

Process indicators Appropriate r...