Are we overtreating nursing home patients with diabetes?
PhD candidate Lillan Mo Andreassen have investigated drug therapy and glycemic control in nursing home patients with diabetes, and found very low blood glucose levels in several of them.
Diabetes is becoming an increasing challenge, especially in the older population. Guidelines for treatment and monitoring of diabetes in older patients have been either inadequate or lacking until recently, and knowledge of how the disease is managed in the nursing home population have been sparse.
By examining 742 patients from 19 nursing homes in the western part of Norway, Andreassen found that 116 patients had a known diagnosis of diabetes (16%). Three out of four patients received blood glucose lowering drugs to treat their diabetes, and nearly half of the patients were prescribed insulin. Further investigation of the levels of blood glucose in these patients gave an indication that some of this drug therapy may be unnecessary. The last four weeks 60% of the patients had documented at least one episode of hypoglycemia or risk of hypoglycemia. We don’t know if they expressed clinical symptoms of hypoglycemia, but we do know that hypoglycemia is often overlooked in these patients, Andreassen says. Hypoglycemia is associated with increased risk of dementia, cardiovascular events and death, she continues.
Another indication of overtreatment was reflected in the periodic glucose levels, known as HbA1c values. Recommended HbA1c value in older patients lies within the interval 7-8%, or over 8% if the patient is very frail. Only a fourth of the patients were within the recommended interval, and 46% were below 7%, a level which increases the risk of hypoglycemia in these patients. Limited knowledge of the new guidelines could explain part of these findings, Andreassen says and urges the nursing homes to make better use of them in the future. However, this population is not heterogeneous, which is why individual care planning should be applied, especially in aspect of the patient’s critical blood glucose limits, she concludes.
Read more in the paper «Nursing home patients with diabetes: Prevalence, drug treatment and glycemic control», published in Diabetes Research and Clinical Practice.