Clinical Practice Guideline: Diabetes Management

Diabetes is an independent predictor of long term care (LTC) facility placement in the elderly. Residents of LTC facilities who have diabetes are a vulnerable group who often take multiple medications and who experience frequent infections, high rates of cardiovascular complications, dehydration, hospitalizations, hyperosmolar states, and physical and cognitive disability. Diabetes causes serious morbidity and mortality from macrovascular and microvascular complications. Evidence is mounting that insulin resistance and diabetes increase the risk of cognitive impairment and dementia. People with diabetes are more likely to experience depression, which has been shown to be a major factor in hospital admissions and death. The prevalence of functional disability and multiple comorbid conditions in the LTC population increases the complexity of diabetes management. Hyperglycemia impairs cognition and, when untreated, may contribute to further functional decline in patients with dementia. Additionally, hyperglycemia decreases pain thresholds, impairs vision, impedes wound healing, and may increase the risk for falls.

A comprehensive approach to diabetes management may improve glycemic control and reduce the progression of existing complications that result in morbidity and premature mortality. This guideline recommends processes that, if implemented, should help LTC facilities to systematically manage and improve the care of residents with diabetes.

Potential benefits associated with the implementation of this guideline include the following:

• Greater individualization of care.
• Enhanced quality of life.
• Earlier identification of diabetes and its complications.
• Better documentation of, and rationale for, patients' personal goals and decision-making processes regarding their disease and its treatment.
• A decline in the rate of hypoglycemic and hyperglycemic events.
• A decline in the frequency of infection, electrolyte imbalance, and dehydration.
• A decline in the rate of progression of diabetic complications.
• A reduction in emergency room visits and hospitalizations caused by uncontrolled diabetes.
• A reduction in direct and indirect patient care costs as a result of more appropriate resource utilization.
• Improved monitoring and treatment protocols.
• Improved staff education and awareness of this complex progressive disease.

Order Information:
Product Code: CPG15
Member Price: $15
Non-member Price: $35
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For additional information, visit the Clinical Corner on Diabetes.