August 2, 2023
Authors of studies published in JAMDA very often feel a great passion for their subject matter, and this was clear in a recent episode of the JAMDA On-The-Go podcast. During the program, Naushira Pandya, MD, CMD, talked about her study, Medication Prescribing for Type 2 Diabetes in the US Long-Term Care Setting: Observational Study. “One reason I wanted to do this study was the high prevalence of diabetes in long-term care,” where, she said, up to 44% of patients have the condition, and there are large fluctuations in glucose control and high use of sliding scale insulin.
Among Dr. Pandya’s findings was that during each study year, 35% of long-term care residents with Type 2 Diabetes Mellitus experienced level 1 hypoglycemia including 10% to 12% of those prescribed only oral agents and 44 more of those prescribed injectable agents. Overall, 24% to 25% of residents experienced level 2 hypoglycemia. The study’s findings suggest opportunities for improving diabetes management in the long-term care setting.
Dr. Pandya offered some take-home messages from her study. “It is important to individualize control and identify goals for each patient,” she said. “Involve the interdisciplinary team and look at the facility’s performance on diabetes management.”
The next step, Dr. Pandya said, “is to provide a simple roadmap that clinicians can follow, a plan that guides clinicians on therapeutic choices they can make.” AMDA is revising its Clinical Practice Guideline on diabetes, and Dr. Pandya noted that this will help. She observed, “We are trying to shorten the guideline and work with the team to create a roadmap on choosing medications for each patient.” An algorithmic approach, she said, will help guide decisions.
The podcast addressed other articles in the June issue of JAMDA. Among them was Pathways into Assisted Living Communities: Admission Limitations and Assessment Requirements Across the United States. This study was designed to address the limitations to admission that play a critical role in shaping the composition of residents living in licensed assisted living communities. The authors observed variations implying that state agencies have created multiple licensure classifications that serve as a mechanism for sorting types of residents into settings based on their needs.
JAMDA Co-Editor-in-Chief Barbara Resnick, PhD, CRMP, said, “I like this article because it raised the discussion” about assisted living and how to bring residents into the right setting for them. She noted that this conversation will grow in the coming years as more residents are seeking to age in place. In the meantime, she noted that communities need to ensure that staff have the necessary skills to provide care for all residents and that it will be helpful to look at scopes of practice for those working in assisted living.
Listen to the complete podcast to hear more discussion on these articles, as well as Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care? and Does Multicomponent Training Improve Cognitive Function in Older Adults Without Cognitive Impairment? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
