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Cited by 60Diabetes Treatment and ManagementGeriatric Care and Nursing HomesDiabetes Management and Research

Nursing home patients with diabetes: prevalence, drug treatment and glycemic control

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Andreassen, Lillan Mo, Sandberg, Sverre, Kristensen, Gunn Berit Berge, Sølvik, Una Ørvim, Kjome, Reidun Lisbet Skeide·2014·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2014.04.012
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Abstract

AIMS: Determine prevalence of diabetes, and describe use of blood glucose lowering (BGL) drugs and glycemic control in Norwegian nursing homes. METHODS: In this cross-sectional study we collected details of BGL drugs, capillary blood glucose measurements (CBGM) in the last four weeks and HbA1c measurements in the last 12 months from the medical records of patients with diabetes, within a population of 742 long-term care patients from 19 randomly selected nursing homes in Western Norway. Descriptive statistics were applied, and Pearson's chi-squared (P≤0.05) or non-overlapping 95% confidence intervals were interpreted as significant effects. RESULTS: 116 patients (16%) had diabetes, 100 of these gave informed consent and medical data were available. BGL treatment was as follows: (1) insulin only (32%), (2) insulin and oral antidiabetics (OADs) (15%), (3) OADs only (27%) and (4) no drugs (26%). Patients with cognitive impairment were less likely to receive medical treatment (P=0.04). CBGM and HbA1c measurements were performed for 73% and 77% of patients, respectively. Mean HbA1c was 7.3% (57 mmol/mol), 46% of patients had an HbA1c <7.0% (53 mmol/mol), and CBGM consistent with risk of hypoglycemia was found for 60% of these patients. CONCLUSIONS: Prevalence of diabetes and BGL treatment in Norwegian nursing homes is comparable to other European countries. Although special care seems to be taken when choosing treatment for patients with cognitive impairment, there are signs of overtreatment in the population as a whole. The strict glycemic control unveiled may negatively affect these frail patients' quality of life and increase the risk of early death.

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  • Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment.

    “Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment and found to be very common in clinical practice (100-104)”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [101]

    The Discussion says low glucose readings in nursing home patients may indicate overtreatment, and reports that 46% of patients with a recent HbA1c measurement were below the recommended 7.0% limit. The drug-regimen results document insulin and sulfonylurea prescriptions, but the paper does not identify use of either drug itself as overtreatment or establish the claim for older adults beyond nursing homes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Intensive glycemic management with insulin and sulfonylureas in older adults with complex medical conditions is very common in clinical practice.

    “Intensive glycemic management with medication plans including insulin and sulfonylureas in older adults with complex medical conditions has been identified as overtreatment and found to be very common in clinical practice (100-104)”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [101]

    The Drug regime section reports insulin prescriptions for 47 of 100 nursing-home patients and glimepiride, a sulfonylurea, for 18. The Discussion reports that 46% of patients with a recorded HbA1c were below the recommended threshold, and says low glucose readings may indicate overtreatment. These findings support concern about common intensive treatment in this frail population, but do not establish that insulin-and-sulfonylurea plans are themselves overtreatment or that such plans are very common across older adults in clinical practice generally. Page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Intensive glycemic management in older adults with complex health status and medication plans that increase hypoglycemia risk through insulin and/or sulfonylureas has been identified as overtreatment and is common in clinical practice.

    “Intensive glycemic management in older adults, particularly those with complex health status, with medication plans that increase the risk of hypoglycemia through use of insulin and/or sulfonylureas has been identified as overtreatment, is common in clinical practice”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [110]

    The Discussion (page unavailable) says low glucose readings, low HbA1c values, and substantial insulin use suggest that some Norwegian nursing-home patients were overtreated. It does not establish that insulin- or sulfonylurea-based intensive treatment is commonly identified as overtreatment across older adults in clinical practice; its overtreatment conclusion is tentative and specific to the nursing-home population. (LLM, conf=0.86)

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Cited by

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Authors
Andreassen, L. M., Sandberg, S., Kristensen, G. B. B., Sølvik, U. Ø., & Kjome, R. L. S.
Affiliations
University of Bergen (NO)
Corresponding author
Andreassen, Lillan Mo
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2014-07
Volume
105
Issue
1
Pages
102-109
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2014.04.012
OpenAlex
W2095967674
Cited by
60
References
5
Citations by year
2026: 2 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 7 · 2020: 9 · 2019: 4 · 2018: 4 · 2017: 7 · 2016: 5 · 2015: 1 · 2014: 1
FWCI
3.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-sa)
Funders
Norges Forskningsråd (195475)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes prevalence, nursing homes, glycemic control, insulin, oral antidiabetic drugs, HbA1c, capillary blood glucose monitoring, hypoglycemia, cognitive impairment, long-term care, overtreatment, frail elderly patients
MeSH terms
Aged, 80 and over, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Long-Term Care, Male, Norway, Nursing Homes, Prevalence

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