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Review
. 2022 Jul;10(4):e002705.
doi: 10.1136/bmjdrc-2021-002705.

Update on the management of diabetes in long-term care facilities

Thaer Idrees  1 , Iris A Castro-Revoredo  2 , Alexandra L Migdal  2 , Emmelin Marie Moreno  2 , Guillermo E Umpierrez  2
Affiliations
Review

Update on the management of diabetes in long-term care facilities

Thaer Idrees et al. BMJ Open Diabetes Res Care. 2022 Jul.

Abstract

The number of patients with diabetes is increasing among older adults in the USA, and it is expected to reach 26.7 million by 2050. In parallel, the percentage of older patients with diabetes in long-term care facilities (LTCFs) will also rise. Currently, the majority of LTCF residents are older adults and one-third of them have diabetes. Management of diabetes in LTCF is challenging due to multiple comorbidities and altered nutrition. Few randomized clinical trials have been conducted to determine optimal treatment for diabetes management in older adults in LTCF. The geriatric populations are at risk of hypoglycemia since the majority are treated with insulin and have different levels of functionality and nutritional needs. Effective approaches to avoid hypoglycemia should be implemented in these settings to improve outcome and reduce the economic burden. Newer medication classes might carry less risk of developing hypoglycemia along with the appropriate use of technology, such as the use of continuous glucose monitoring. Practical clinical guidelines for diabetes management including recommendations for prevention and treatment of hypoglycemia are needed to appropriately implement resources in the transition of care plans in this vulnerable population.

Keywords: diabetes mellitus, type 1; diabetes mellitus, type 2; geriatrics; hypoglycemia.

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Conflict of interest statement

Competing interests: GEU is a member of the BMJ editorial board.

Figures

Figure 1
Figure 1
Common diabetes-related comorbidities and frequency of occurrence per age. The incidence of diabetes complications divided by age groups among patients with diabetes (per 1000). This figure was reproduced from the CDC data (http://www.cdc.gov/diabetes, accessed 2021). No permission was needed since these data were in the public domain and may be reproduced or copied without permission from CDC. CDC, Centers for Disease Control and Prevention; CHF, congestive heart failure; ESRD, end-stage renal disease; IHD, ischemic heart disease.
Figure 2
Figure 2
Common geriatric syndromes in patients with diabetes in long-term care facilities. DM, diabetes mellitus.
See this image and copyright information in PMC

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