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Cited by 243Diabetes Treatment and ManagementGeriatric Care and Nursing HomesDiabetes Management and Research

Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association

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Munshi, Medha N., Florez, Hermes, Huang, Elbert S., Kalyani, Rita R., Mupanomunda, Maria, Pandya, Naushira, Swift, Carrie S., Taveira, Tracey H. +1 more·2016·Diabetes Care
DOI 10.2337/dc15-2512PMC PMC5317234
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Abstract

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.

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  • Individualization of health care is important for all people with diabetes; however, practical guidance for feasible and sustainable care delivery is needed for health care professionals, PALTC staff, and care partners.

    “Individualization of health care is important for all people with diabetes; however, practical guidance for feasible and sustainable care delivery is needed for health care professionals, PALTC staff, and care partners (163,164).”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [163]

    The General Approach to Care and Integration of Diabetes Management Into LTC Facilities sections support individualized diabetes care and practical guidance for clinical and LTC staff. The paper focuses on older adults in long-term care, rather than all people with diabetes, and does not expressly call for feasible and sustainable guidance for care partners. (LLM, conf=0.84)

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Sorted by citations

Authors
Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., Swift, C. S., Taveira, T. H., & Haas, L. B.
Affiliations
  • Joslin Diabetes Center (US)
  • University of Miami (US)
  • University of Chicago (US)
  • Johns Hopkins University (US)
  • American Diabetes Association (US)
  • Nova Southeastern University (US)
  • Kadlec Regional Medical Center (US)
  • University of Rhode Island (US)
  • Private Consultant, Seattle, WA
Corresponding author
Munshi, Medha N.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-01-11
Volume
39
Issue
2
Pages
308-318
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc15-2512
PMC
PMC5317234
OpenAlex
W2268433237
Cited by
243
References
8
Citations by year
2026: 15 · 2025: 21 · 2024: 21 · 2023: 22 · 2022: 31 · 2021: 19 · 2020: 26 · 2019: 24 · 2018: 27 · 2017: 27 · 2016: 10
FWCI
29.49
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • Journal of Media Literacy Education (submittedVersion, cc-by)
  • NSUWorks (Nova Southeastern University) (submittedVersion)
Funders
  • Agency for Healthcare Research and Quality (R01HS018542)
  • U.S. Public Health Service (UB4HP19211)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24DK105340, K23DK093583, P30DK092949)
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 management, long-term care, skilled nursing facilities, older adults, hypoglycemia risk, glycemic targets, sliding scale insulin, glucose-lowering agents, comorbidities, care transitions, end-of-life care, palliative care, hospice care, interprofessional team care, quality of life
MeSH terms
Adult, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Long-Term Care, Middle Aged, Quality of Life, Skilled Nursing Facilities, United States, Comorbidity, Prevalence, Disease Management, Diabetes Complications

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