Objectives: The management of diabetes in long-term care (LTC) facilities requires facility staff to perform most diabetes self-care activities on the behalf of the residents. We describe a practical model of care to improve diabetes management in LTC facilities.
Design and Methods: A diabetes management model of care was developed and implemented at six LTC facilities over 4-year period. The components of the program included: 1) developing individualized curriculum, and educating interdisciplinary staff members, 2) educating patients and families, and 3) developing a practical clinical care algorithm. Staff members were trained to identify the most likely reasons for hypo- or hyperglycemic episodes and intervention strategies based on the causes.
Results: Over 500 LTC staff members were educated and achieved competence during the program implementation. The patients and families received on an average 12.5 education sessions per month in skilled nursing facilities, and 1.5 education sessions per month in nursing homes. A total of 1031 residents were screened to assess risk of hypo- or hyperglycemia on admission to LTC. During the first 2 weeks of stay, hypo- and hyperglycemic episodes occurred in 31.4% and 29.2% of residents respectively. Overall, 245 residents (23.8%) experienced ≥1 episode of hypoglycemia (glucose <70mg/dl). Of those 245 residents, 66.5% had 1 event, 15.5% had 2 events, and 18.0% had ≥3 events. Similarly, 240 residents (23.3%) experienced ≥1 episode of hyperglycemia (≥3 consecutive glucose readings >200 mg/dl) with 63.7% having 1 event, 17.9% with 2 events, and 18.4% having ≥3 events. The most common cause of either hypo- or hyperglycemia was found to be medication related. The hypoglycemia episodes resolved without recurrence in 73-90% cases and interventions reduced the number of events over time.
Conclusion: Implementation of a practical model of diabetes management in LTC facilities can improve staff education leading to improved diabetes management for all residents.
S.L. Sy: None. M. Munshi: Consultant; Self; Eli Lilly and Company, Sanofi.