Diabetes
A very large percentage of long term care patients suffer from Diabetes. Diabetes is a chronic health condition where the body is unable to produce insulin and properly break down sugar (glucose) in the blood. Symptoms include hunger, thirst, excessive urination, dehydration and weight loss. Check our archives for Diabetes articles and information.
The Older Patient with Type 2 Diabetes: Special Considerations and Management with Insulin
It is well established that diabetes prevalence in the United States has reached an epidemic level and continues to increase. As the risk for diabetes increases with age, the importance of screening for diabetes among older patients is critical. Once diagnosed, diabetes in older persons must be managed on an individualized basis, according to the underlying comorbidities, level of functioning, and life expectancy of the patient. The health status of patients in older populations varies considerably; for many patients with a higher functional status, tight glycemic control is appropriate. Because these patients can benefit greatly from intensive therapy, it is important to identify and treat these older individuals without unnecessary delay. Treatment to glycemic targets eventually may require insulin therapy, either in combination with oral agents or alone in regimens that approach physiologic insulin secretion (ie, basal-prandial regimens). Caregivers should consider carefully the risks and benefits of insulin therapy for older patients with diabetes on a case-by-case basis, because insulin can safely provide the level of efficacy needed to reach and maintain glycemic targets for many patients. (Annals of Long-Term Care: Clinical Care and Aging 2007;14[11]:17-24)
Psychiatric Disorders and Psychotropic Medication Use in Elderly Persons with Diabetes
Type 2 diabetes is rising in epidemic proportions due to increases in lifestyle risk factors and the aging of the population. Cognitive disorders, depression, and alcohol abuse are notable psychiatric conditions that clinicians treat in patients with diabetes. Cognitive deficits and dementia prevalence are higher in persons with diabetes. While prevalence of depression is high, it is recognized and treated in fewer than 25% of persons with diabetes. Heavy alcohol intake increases the risk of developing diabetes and worsens existing diabetes. Psycho-tropic medications are prescribed for many conditions in diabetes. Clinicians treat painful diabetic peripheral neuropathy with antidepressants and mood stabilizers, which may deliver low efficacy or have notable risks in this population. Antidepressants and atypical antipsychotics are prescribed for depression and dementia, respectively, and may have side effects that can worsen diabetes. Thus, in older persons with type 2 diabetes, treatment with psychotropic medications requires careful consideration of risks and benefits. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[7]:39-47)
Diabetes Management: The Hidden Challenge of Managing Hyperglycemia in Long-Term Care Settings
Diabetes is common in older adults living in long-term care facilities, and has a significant impact on quality of life. Residents in long-term care facilities may not be particularly concerned about the micro- and macrovascular disease associated with diabetes, and they may not be interested in rigidly controlling blood sugars to prevent further vascular complications. Rather, it is the day-to-day impact of diabetes management on functional activities, mood, cognition, and quality of life that is relevant to these individuals. It is therefore particularly important to consider the daily impact of diabetes on these residents and the more commonly ignored and neglected problem of hyperglycemia. This article reviews the way in which optimal care can be provided for long-term care residents with diabetes by combining behavioral interventions with appropriate medication management. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[8]:26-32)
An Algorithim for Managing Type 2 Diabetes: A Focus on the Disease Process, Not Just the Sugar
This supplement reviews the pathophysiology of type 2 diabetes, the oral pharmacologic treatment of type 2 diabetes, and proposed treatment algorithms, which are stratified based on fasting plasma glucose levels. Two recently stopped studies, the Diabetes Prevention Trial Type 1 (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT), showed no benefit of insulin (oral or low-dose injected) or nicotinamide, respectively.26,27 Trials that have been traditionally thought of ...
Efficacy of New Drug Therapies for Diabetes in the Elderly
Oral Agents for the Treatment of Type 2 Diabetes The Table lists the categories of drugs available to treat type 2 diabetes. Glimepiride has a marked insulin secretory effect, both in vitro and in vivo, increasing plasma insulin levels by as much as 50% in patients with type 2 diabetes. Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.
August 2004An Algorithm for Managing Type 2 Diabetes: A Focus on the Disease Process, Not Just the Sugar
This supplement reviews the pathophysiology of type 2 diabetes, the oral pharmacologic treatment of type 2 diabetes, and proposed treatment algorithms, which are stratified based on fasting plasma glucose levels. Two recently stopped studies, the Diabetes Prevention Trial Type 1 (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT), showed no benefit of insulin (oral or low-dose injected) or nicotinamide, respectively.26,27 Trials that have been traditionally thought of ...
Postoperative Management of Diabetes Mellitus
Postoperative Postoperative considerations for oral glucose- lowering drugs and insulin are summarized in Table I. Patients with type 1 DM cannot have insulin withheld. The population with type 2 diabetes often requires insulin for adequate glycemic control in the postoperative state. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: A randomized prospective 6-year study.
Management of Diabetes Mellitus in the Nursing Home
Management of Diabetes Mellitus in the Nursing Home Management of Diabetes Mellitus in the Nursing Home Abstract Diabetes mellitus affects a large proportion of patients in the nursing home. To date, there are no clear guidelines for optimizing treatment of patients with diabetes in nursing homes. However, the more complicated issues are whether to treat early asymptomatic diabetes in this population and the appropriate intensity of treatment for symptomatic patients with diabetes in the ...
Oral Agent Treatment of Diabetes Mellitus in Older Adults
Diabetes Treatment Outcomes in Nursing Facility Patients The longest study of diabetes mellitus treatment outcomes in the nursing facility from the current literature covers three years.8 A group of 41 patients were retrospectively divided according to the treatment they received into four groups: oral sulfonylurea hypoglycemic agents and diet (five patients); insulin and diet (25 patients); diet alone (nine patients); and no dietary or drug treatment (two patients). Sulfonylurea Agents in ...
Management of Diabetes Mellitus in the Nursing Home
Diabetes mellitus (DM) is common in older adults and frequently affects residents of nursing homes (NH). Most have complex health status owing to comorbid illness, frailty, and the presence of geriatric syndromes. This complexity increases the risk of adverse events related to treatment. As a result, management of DM in the NH setting requires supreme clinical judgment that balances an understanding of the effects of comorbidity, functional disability, and geriatric syndromes with the resident?s healthcare preferences and estimated life expectancy. Developing goals of care and implementing treatment plans requires knowledge of the balance of potential benefits and burdens of certain treatments, including lifestyle modification and pharmacotherapy. Prevention of macrovascular complications through intensive blood pressure and lipid management is achievable in a much shorter time period than the prevention of microvascular complications through intensive glycemic control. Furthermore, it is often necessary and important to address geriatric syndromes, which may significantly impact the resident?s quality of life. (Annals of Long-Term Care: Clinical Care and Aging 2007;15[5]:27-33)
It is well established that diabetes prevalence in the United States has reached an epidemic level and continues to increase. As the risk for diabetes increases with age, the importance of screening for diabetes among older patients is critical. Once diagnosed, diabetes in older persons must be managed on an individualized basis, according to the underlying comorbidities, level of functioning, and life expectancy of the patient. The health status of patients in older populations varies considerably; for many patients with a higher functional status, tight glycemic control is appropriate. Because these patients can benefit greatly from intensive therapy, it is important to identify and treat these older individuals without unnecessary delay. Treatment to glycemic targets eventually may require insulin therapy, either in combination with oral agents or alone in regimens that approach physiologic insulin secretion (ie, basal-prandial regimens). Caregivers should consider carefully the risks and benefits of insulin therapy for older patients with diabetes on a case-by-case basis, because insulin can safely provide the level of efficacy needed to reach and maintain glycemic targets for many patients. (Annals of Long-Term Care: Clinical Care and Aging 2007;14[11]:17-24)
Type 2 diabetes is rising in epidemic proportions due to increases in lifestyle risk factors and the aging of the population. Cognitive disorders, depression, and alcohol abuse are notable psychiatric conditions that clinicians treat in patients with diabetes. Cognitive deficits and dementia prevalence are higher in persons with diabetes. While prevalence of depression is high, it is recognized and treated in fewer than 25% of persons with diabetes. Heavy alcohol intake increases the risk of developing diabetes and worsens existing diabetes. Psycho-tropic medications are prescribed for many conditions in diabetes. Clinicians treat painful diabetic peripheral neuropathy with antidepressants and mood stabilizers, which may deliver low efficacy or have notable risks in this population. Antidepressants and atypical antipsychotics are prescribed for depression and dementia, respectively, and may have side effects that can worsen diabetes. Thus, in older persons with type 2 diabetes, treatment with psychotropic medications requires careful consideration of risks and benefits. (Annals of Long-Term Care: Clinical Care and Aging 2006;14[7]:39-47)
Diabetes is common in older adults living in long-term care facilities, and has a significant impact on quality of life. Residents in long-term care facilities may not be particularly concerned about the micro- and macrovascular disease associated with diabetes, and they may not be interested in rigidly controlling blood sugars to prevent further vascular complications. Rather, it is the day-to-day impact of diabetes management on functional activities, mood, cognition, and quality of life that is relevant to these individuals. It is therefore particularly important to consider the daily impact of diabetes on these residents and the more commonly ignored and neglected problem of hyperglycemia. This article reviews the way in which optimal care can be provided for long-term care residents with diabetes by combining behavioral interventions with appropriate medication management. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[8]:26-32)
This supplement reviews the pathophysiology of type 2 diabetes, the oral pharmacologic treatment of type 2 diabetes, and proposed treatment algorithms, which are stratified based on fasting plasma glucose levels. Two recently stopped studies, the Diabetes Prevention Trial Type 1 (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT), showed no benefit of insulin (oral or low-dose injected) or nicotinamide, respectively.26,27 Trials that have been traditionally thought of ...
Oral Agents for the Treatment of Type 2 Diabetes The Table lists the categories of drugs available to treat type 2 diabetes. Glimepiride has a marked insulin secretory effect, both in vitro and in vivo, increasing plasma insulin levels by as much as 50% in patients with type 2 diabetes. Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.
August 2004An Algorithm for Managing Type 2 Diabetes: A Focus on the Disease Process, Not Just the Sugar
This supplement reviews the pathophysiology of type 2 diabetes, the oral pharmacologic treatment of type 2 diabetes, and proposed treatment algorithms, which are stratified based on fasting plasma glucose levels. Two recently stopped studies, the Diabetes Prevention Trial Type 1 (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT), showed no benefit of insulin (oral or low-dose injected) or nicotinamide, respectively.26,27 Trials that have been traditionally thought of ...
Postoperative Postoperative considerations for oral glucose- lowering drugs and insulin are summarized in Table I. Patients with type 1 DM cannot have insulin withheld. The population with type 2 diabetes often requires insulin for adequate glycemic control in the postoperative state. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: A randomized prospective 6-year study.
Management of Diabetes Mellitus in the Nursing Home Management of Diabetes Mellitus in the Nursing Home Abstract Diabetes mellitus affects a large proportion of patients in the nursing home. To date, there are no clear guidelines for optimizing treatment of patients with diabetes in nursing homes. However, the more complicated issues are whether to treat early asymptomatic diabetes in this population and the appropriate intensity of treatment for symptomatic patients with diabetes in the ...
Diabetes Treatment Outcomes in Nursing Facility Patients The longest study of diabetes mellitus treatment outcomes in the nursing facility from the current literature covers three years.8 A group of 41 patients were retrospectively divided according to the treatment they received into four groups: oral sulfonylurea hypoglycemic agents and diet (five patients); insulin and diet (25 patients); diet alone (nine patients); and no dietary or drug treatment (two patients). Sulfonylurea Agents in ...
Diabetes mellitus (DM) is common in older adults and frequently affects residents of nursing homes (NH). Most have complex health status owing to comorbid illness, frailty, and the presence of geriatric syndromes. This complexity increases the risk of adverse events related to treatment. As a result, management of DM in the NH setting requires supreme clinical judgment that balances an understanding of the effects of comorbidity, functional disability, and geriatric syndromes with the resident?s healthcare preferences and estimated life expectancy. Developing goals of care and implementing treatment plans requires knowledge of the balance of potential benefits and burdens of certain treatments, including lifestyle modification and pharmacotherapy. Prevention of macrovascular complications through intensive blood pressure and lipid management is achievable in a much shorter time period than the prevention of microvascular complications through intensive glycemic control. Furthermore, it is often necessary and important to address geriatric syndromes, which may significantly impact the resident?s quality of life. (Annals of Long-Term Care: Clinical Care and Aging 2007;15[5]:27-33)