The Prevalence and Persistence of Sliding Scale Insulin Use Among Newly Admitted Elderly Nursing Home Residents With Diabetes Mellitus
Abstract
Objective To evaluate the initiation and persistence of sliding scale insulin (SSI) therapy in elderly nursing home (NH) residents.Design and participants A longitudinal study of NH residents (N = 9804) with diabetes aged 65 years and older who were admitted between 2002 and 2003 and resided for 1 month or longer in long-term care facilities associated with a for-profit nursing home chain.Results Rates of SSI use were high among patients who were started on insulin during their stay in nursing homes (54%), and 22% of the total number of orders for insulin were for SSI. After insulin initiation, 83% of residents who were started on SSI remained on it by the end of the study. Of those who had not started on SSI, 33% were later switched to SSI.Discussion This study demonstrated that SSI regimens were highly prevalent and, once initiated, tended to be continued in the treatment of elderly patients with diabetes newly admitted to nursing homes. Multiple factors were found to be significantly associated with initiation and persistence of SSI.Conclusion The high prevalence and persistent use of SSI is inconsistent with the American Medical Directors Association guideline as well as current recommendations. Additional studies are needed to evaluate outcomes associated with prolonged SSI use in long-term care facilities.
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One study showed that 83% of residents started on SSI were still treated by SSI alone 6 months later.
“One study showed that 83% of residents started on SSI were still treated by SSI alone 6 months later129.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [129]
Cites
Standards of Medical Care in Diabetes
Power, D. V. (2006) · Diabetes Care · doi:10.2337/diacare.29.02.06.dc05-1593 · Cited by 8,672 · see citing works
MDS Cognitive Performance Scale(C)
Morris, J. N., Fries, B. E., Mehr, D. R., Hawes, C., Phillips, C., Mor, V., & Lipsitz, L. A. (1994) · Journal of Gerontology · doi:10.1093/geronj/49.4.m174 · Cited by 1,852 · see citing works
Morris, J. N., Fries, B. E., & Morris, S. A. (1999) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/54.11.m546 · Cited by 1,408 · see citing works
Designing the National Resident Assessment Instrument for Nursing Homes
Morris, J., Hawes, C., Fries, B. E., Phillips, C. D., Mor, V., Katz, S. R., Murphy, K., Drugovich, M. L., & Friedlob, A. S. (1990) · The Gerontologist · doi:10.1093/geront/30.3.293 · Cited by 925 · see citing works
Umpierrez, G. E., Smiley, D., Zisman, A., Prieto, L. M., Palacio, A., Ceron, M., Puig, A., & Mejia, R. (2007) · Diabetes Care · doi:10.2337/dc07-0295 · Cited by 671 · see citing works
Hartmaier, S. L., Sloane, P. D., Guess, H. A., Koch, G. G., Mitchell, C. M., & Phillips, C. D. (1995) · The Journals of Gerontology Series A · doi:10.1093/gerona/50a.2.m128 · Cited by 521 · see citing works
American College of Endocrinology Position Statement on Inpatient Diabetes and Metabolic Control
Garber, A. J., Moghissi, E. S., Bransome, E. D., Clark, N. G., Clement, S. C., Cobin, R. H., Furnary, A. P., Hirsch, I. B., Levy, P., Roberts, R., et al. (2004) · Endocrine Practice · doi:10.4158/ep.10.s2.4 · Cited by 406 · see citing works
Glycemic Control and Sliding Scale Insulin Use in Medical Inpatients With Diabetes Mellitus
Queale, W. S. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.1997.00440260101014 · Cited by 333 · see citing works
The national nursing home survey: 1999 summary
Jones, A. (2002) · PsycEXTRA Dataset · doi:10.1037/e309012005-001 · Cited by 170 · see citing works
Analyses of Nursing Home Residents With Diabetes at Admission
Travis, S. S., Buchanan, R. J., Wang, S., & Kim, M. (2004) · Journal of the American Medical Directors Association · doi:10.1016/s1525-8610(04)70021-3 · Cited by 82 · see citing works
Dickerson, L. M. (2003) · The Annals of Family Medicine · doi:10.1370/afm.2 · Cited by 64 · see citing works
Golightly, L. K., Jones, M. A., Hamamura, D. H., Stolpman, N. M., & McDermott, M. T. (2006) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.26.10.1421 · Cited by 60 · see citing works
Hospitalizations, Nursing Home Admissions, and Deaths Attributable to Diabetes
Russell, L. B., Valiyeva, E., Roman, S. H., POGACH, L. M., Suh, D., & Safford, M. M. (2005) · Diabetes Care · doi:10.2337/diacare.28.7.1611 · Cited by 52 · see citing works
McNabney, M., Pandya, N., Iwuagwu, C. U., Patel, M., Katz, P., James, V., Calabrese, B., & Lawhorne, L. (2005) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2005.05.012 · Cited by 51 · see citing works
Self-citationKitabchi, A. E., & Nyenwe, E. A. (2007) · Diabetes Care · doi:10.2337/dc07-1141 · Cited by 21 · see citing works
70/30 Insulin Algorithm Versus Sliding Scale Insulin
Schoeffler, J. M., Rice, D. A. K., & Gresham, D. G. (2005) · Annals of Pharmacotherapy · doi:10.1345/aph.1e661 · Cited by 21 · see citing works
Lorber, D. L. (2001) · Diabetes Care · doi:10.2337/diacare.24.11.2011-a · Cited by 19 · see citing works
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Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., Heller, S. R., Rodriguez, H., Rosenzweig, J., & Vigersky, R. (2013) · Diabetes Care · doi:10.2337/dc12-2480 · Cited by 1,389 · see citing works
“Arbitrary short-acting insulin sliding scales, which are used much too often in long-term care facilities (60), should be avoided, and glyburide should be discontinued in favor of shorter-acting insulin secretagogues or medications that do not cause hypoglycemia.”
BackgroundDiabetes in Older Adults: A Consensus Report
Sue Kirkman, M., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., et al. (2012) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12035 · Cited by 548 · see citing works
Seaquist, E. R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., Heller, S. R., Rodriguez, H., Rosenzweig, J., & Vigersky, R. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-4127 · Cited by 412 · see citing works
Feldman, S. M., Rosen, R., & DeStasio, J. (2009) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2009.02.010 · Cited by 70 · see citing works
Inpatient hyperglycemia and transitions of care: A systematic review
Lansang, M. C., Zhou, K., & Korytkowski, M. T. (2021) · Endocrine Practice · doi:10.1016/j.eprac.2021.01.016 · Cited by 9 · see citing works
- Authors
- PANDYA, N., THOMPSON, S., & SAMBAMOORTHI, U.
- Affiliations
- Nova Southeastern University (US)
- Sanofi (United States) (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- PANDYA, N
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2008-11
- Volume
- 9
- Issue
- 9
- Pages
- 663-669
- ISSN
- 1525-8610 (ISSN-L)
- OpenAlex
- W2114545570
- Cited by
- 43
- References
- 17
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 1 · 2017: 3 · 2016: 2 · 2015: 4 · 2014: 3 · 2013: 9 · 2012: 3
- FWCI
- 7.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- NSUWorks (Nova Southeastern University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- sliding scale insulin, diabetes mellitus, nursing home residents, elderly patients, insulin initiation, long-term care, nursing home admission, for-profit nursing homes
- MeSH terms
- Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Female, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Longitudinal Studies, Male, Nursing Homes, United States
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