American Diabetes Association releases first-ever guidelines for managing diabetes in LTC

Hypoglycemia and care transitions are among the topics in the first-ever guidelines relating to diabetes management in long-term care facilities.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities,” released Tuesday by the American Diabetes Association, highlights the differences in diabetes management for younger and older people. The guidelines primarily focus on type 2 diabetes, since the majority of diabetic long-term care residents have that type, according to the ADA.

For older diabetes patients, especially those needing long-term care, hypoglycemia risk, commonly known as low blood sugar, is the most important factor in determining glycemic goals, the guidelines warn. Long-term care residents need plans that strike a balance in maintaining glycemic levels, the guidelines suggest.

Long-term care facilities should also avoid sole use of sliding scale insulin, as it leads to wide variations in blood glucose levels, is a burden for patients and uses up more nursing time and resources, the ADA notes. Liberal diet plans are also preferable for diabetic residents, compared to therapeutic diets, as more food choices benefits nutritional needs and glycemic control.

The ADA statement also stresses the importance of communication between healthcare providers and the need for patient documentation to be transferred between facilities.

For end-of-life care, ADA recommends providers relax glycemic targets, simplify regimens and respect patients' right to refuse diabetes treatment.

The full guidelines can be found in the February issue of Diabetes Care.