New Guidance on Diabetes Care in Elderly Residential Facilities
New American Diabetes Association (ADA) guidelines addressing diabetes management in long-term care and skilled nursing facilities emphasize treatment simplification, avoidance of hypoglycemia, and the need to reassess therapeutic goals for patients who are nearing the end of life. Previous statements from the ADA have addressed care for the elderly in community settings and diabetes care among hospitalized patients, but this is the first to specifically address the unique needs of patients in long-term care settings, where the approach to diabetes management often needs to be dramatically altered from those in younger and healthier patients.
The guidelines are aimed at a variety of audiences. For endocrinologists and primary-care clinicians with expertise in diabetes, they provide additional information about the special considerations in institutionalized elderly patients. This includes guidance on the assessment of functional capacity and common comorbidities that may interfere with diabetes care and strategies for simplifying treatment regimens — the opposite of the usual practice of adding more medications.