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Published online March 10, 2007
Diabetes Care 30:1454-1458, 2007
DOI: 10.2337/dc06-2311
© 2007 by the American Diabetes Association
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Epidemiology/Health Services/Psychosocial Research
Original Article

Diabetes Care in Extended-Care Facilities

Appropriate intensity of care?

Rachel M. Holt, OMSII1, Frank L. Schwartz, MD1,2 and Jay H. Shubrook, DO1,2

1 Ohio University College of Osteopathic Medicine, Athens, Ohio
2 Appalachian Rural Health Institute Diabetes Center, Athens, Ohio

Address correspondence and reprint requests to Rachel M. Holt, OMSII, Cornwell Center, 65 Hospital Dr., Athens, OH 45701. E-mail: rh185305{at}ohio.edu

OBJECTIVE—The American Diabetes Association (ADA) does not recognize different treatment goals for the institutionalized adult compared with the outpatient adult with diabetes, nor has it outlined specific recommendations for this population. The purpose of this study was to examine physician management of patients with type 1 and type 2 diabetes residing in extended-care facilities and to compare this management with ADA standards of care for the outpatient adult.

RESEARCH DESIGN AND METHODS—This retrospective chart review included data from 108 residents with type 1 or type 2 diabetes at 11 extended health care facilities in the Midwestern U.S. and included a review of the medical problem list, medication list, laboratory reports, and all physician and consultation notes during the study period.

RESULTS—Blood glucose was monitored in 98% of the subjects, and 38% met glucose goals. A1C goal was achieved in 67% of patients. Blood pressure was monitored in 94% of patients, with 55% meeting goal. Thirty-one percent of patients had yearly lipids checked, 37% had annual electrocardiograms, 7% had urine analyzed for microalbuminuria, 42% were on aspirin, 87% received foot exams, 42% received dilated eye exams, 89% received influenza vaccinations, and 46% received pneumoccocal vaccinations.

CONCLUSIONS—Care of the institutionalized elderly with diabetes fails to meet ADA standards of care for the outpatient adult. Separate practice guidelines are needed for people with diabetes who reside in extended care facilities in order to improve quality and consistency of care.

Abbreviations: ADA, American Diabetes Association • AGS, American Geriatric Society


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