September 13, 2024
Clinical guidance on any issue changes as new medications, interventions, technologies, and best practices emerge and new studies come out. That is certainly true of PALTmed’s Clinical Practice Guidelines (CPGs). The just-revised Diabetes Management in the Post-acute and Long-term Setting CPG includes the latest clinical updates, as well as a user-friendly format and content designed for use by the entire interdisciplinary team.
Naushira Pandya, MD, FACP, CMD, chair of the workgroup that worked on the revisions, offered insights into some of the key changes:
- The CPG is available free to everyone online. Users can click on a specific section in the table of contents and go directly to what they’re interested in. “The electronic format also makes it much easier and quicker for us to update as new drugs or clinical evidence emerges,” says Dr. Pandya.
- The revised guideline will be published in JAMDA. “This is exciting, as JAMDA is read internationally. This will increase dissemination, awareness, and use of the CPG well beyond PALTmed members,” Dr. Pandya observes.
- Tables are streamlined. The workgroup eliminated some and enhanced other tables in the document to increase efficiency and ease of use. There is a new table on the role of each member of the interdisciplinary team. Dr. Pandya also created a table that helps the prescribers, especially new practitioners, determine what drugs to select for different types of patients.
There is a new section on diabetes management in assisted living. The previous version of the CPG, says Dr. Pandya, “didn’t have much on assisted living, but diabetes needs to be managed throughout the continuum of care; and we have many assisted living residents living with diabetes. This section starts off with a case, then a discussion of managing diabetes in this setting.” - References appear at the end of the document with selected references for each section, instead of throughout the document. “We do not feel this guideline is an academic review and believe that changing how we list references is more efficient and increases readability.” Dr. Pandya notes.
- The CPG contains updates on medications. The guideline still has extensive medication tables, but they are updated to reflect current guidance. There also is a price comparison between drugs, which is a new addition.
- The guideline includes a 4M Framework for age-friendly health care specifically for diabetes. “I created this a year ago, and it received positive feedback; so we thought it would be useful to include it in the guideline. It addresses the 4Ms—what matters, medication, mentation, and mobility—as they relate to diabetes. It looks at the issues you need to consider for people living with diabetes regarding care as well as quality of life and well-being,” says Dr. Pandya.
- There is a new section on cardiovascular and renal issues. “We had a geriatric cardiologist work with us on this,” says Dr. Pandya. Many individuals with diabetes have or are at risk for cardiac or renal issues, and it is important to know what drugs are appropriate or contraindicated for people with these comorbidities.
- There is a section on technology. “Technology is here to stay, and it will be very beneficial in long-term care for appropriate patients. Instead of doing finger sticks 3 or 4 times a day, you can have a continuous glucose monitor and a phone app that updates you or a care partner on blood sugars,” Dr. Pandya explains. This section introduces the latest diabetes management devices and technology and how they can be used in this care setting. She says, “Increasingly patients and care partners are embracing this technology, so the team needs to know about it and how to best use it.”
“This is a much more up-to-date guideline. It’s designed for use in post-acute and long-term care with the interdisciplinary team, but it could be applied to the outpatient setting for older adults as well,” says Dr. Pandya. Each organization or team can customize their use of the guideline and identify sections and topics to help them address their concerns, challenges, or questions.