1221-P: Hypoglycemia in Nursing Home Residents Often Co-occurs with Hyperglycemia

During the transitional period following admission to a nursing home (NH), the primary diabetes management goal is to avoid hypoglycemia and hyperglycemia. However, the frequency and severity of hypo- and hyper-glycemic episodes in this population are unclear. Using the Veterans Affairs NH electronic health records, we examined Veterans aged ≥65 years with diabetes, insulin use, and a NH stay ≥7 days from 1 Jan 2016 to 30 Sept 2019. From fingerstick glucose values from Days 1 through 7, we calculated the proportion of Veterans with Level 1 (<70mg/dL) and Level 2 (<54mg/dL) hypoglycemia and with hyperglycemia ≥250mg/dL (recommended upper limit for NH residents) and severe hyperglycemia ≥400mg/dL. Of 12,031 Veterans, mean age was 74.4, 98% were male, 17% were Black and 77% were White. During Days 1-7 of NH stay, the majority (51%) had only hyperglycemia >250mg/dL. Almost one-third (30%) had neither hypo- nor hyper-glycemia, 6% had only hypoglycemia <70mg/dL, and 13% had both hypo- and hyper-glycemia. Among Veterans with Level 1 hypoglycemia, over two-thirds also had hyperglycemia >250mg/dL, and only one-third had Level 2 hypoglycemia. Of Veterans with hyperglycemia ≥250mg/dL, only 16% had hyperglycemia ≥400mg/dL. In conclusion, most hypoglycemia in NH residents using insulin is mild (54-69mg/dL) and often co-occurs with hyperglycemia ≥250mg/dL, suggesting any deintensification in response to hypoglycemia should be coupled with monitoring for worsening hyperglycemia. Future research is needed to determine whether hypoglycemia 54-70mg/dL or hyperglycemia 250-400mg/dL is associated with adverse outcomes in NH residents.