Nursing Home Care for People With Diabetes a Mixed Bag

As the 76-million-member Baby Boomer generation ages-its oldest members are now 63-nursing homes are bracing for an unprecedented demand for their services. Along with increased pressure from the sheer number of patients, nursing homes will also have to deal with the skyrocketing number of seniors with type 2 diabetes.

Even now, before the Boomer deluge, nursing homes are experiencing a mixed bag of success in dealing with their patients with diabetes. A study recently published in Diabetes Care, which says that as many as one in four nursing home residents has diabetes, reports that while 98 percent of them are having their blood glucose levels regularly monitored, only 38 percent of them are meeting their short-term glucose goals. On a more positive note, 67 percent of nursing home residents  with diabetes are meeting their long-term goal of an A1c of less than 7%, according to the study.

Although the homes are good about monitoring blood sugars regularly, it appears that many of them lack the resources or knowledge to deal with the individual needs of diabetic patients. For example, an older patient with dementia who has had diabetes for a long time may be put at risk of hypoglycemia by a one-size-fits-all nursing home regimen that calls for maintaining low blood glucose levels in all patients. Such a patient might not be capable of alerting caretakers to her perilous condition.

Similar concerns extend to insulin pumps. Even experienced pump users, as they age, are more inclined to forgetfulness or unawareness about pumps’ presence or maintenance. Nursing homes in the future may not want to run the risks of depending on insulin pump therapy to help them manage diabetic patients. On the other hand, intensive one-on-one monitoring of patients may be too expensive and time-consuming.

The solution will probably require much family involvement on the part of relatives who will make decisions on behalf of patients, such as whether to go for low blood sugar maintenance or trade higher blood sugar levels for decreased risk of hypoglycemia. 

Advances in pump technology may also produce sturdier, smaller units that can monitor themselves and report impending or occurring problems to a nursing home caretaker.

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