Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.
Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.
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DOI：
10.2337/dc15-2512
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发表时间：
2016-02
期刊：
影响因子：
16.2
通讯作者：
Haas LB
中科院分区：
文献类型：
--
作者：
Munshi MN;Florez H;Huang ES;Kalyani RR;Mupanomunda M;Pandya N;Swift CS;Taveira TH;Haas LB
糖尿病在老年人中更常见，在长期护理（LTC）设施中的患病率很高，并且与显著的疾病负担和更高的成本相关。该人群在合并症和总体健康状况方面的异质性对于建立糖尿病的个性化目标和治疗至关重要。低血糖风险是确定血糖目标的最重要因素，因为在该人群中会产生灾难性后果。首选简化的治疗方案，应避免单独使用滑动标度胰岛素（SSI）。本立场声明为LTC环境中的老年人提供了一个分类系统，描述了如何根据合并症定制糖尿病目标和管理，描述了在该人群中使用降糖药时需要考虑的关键问题，并提供了如何在LTC设施中取代SSI的建议。随着这些患者从一种环境过渡到另一种环境，或从一个提供者过渡到另一个提供者，他们发生不良事件的风险增加。提出了减少这些风险并确保安全过渡的策略。本文介绍了糖尿病管理在生命的尽头，并在那些接受姑息治疗和临终关怀。将糖尿病管理整合到长期护理设施中非常重要，需要跨专业团队的方法。为了促进这种方法，需要行政人员的认可，也需要协议和可能的系统更改。重要的是，临床医生要了解的特点，挑战，和障碍有关的老年人口生活在长期护理设施，以及设施本身的正常运作。一旦确定了这些挑战，就可以设计个性化的方法来改善糖尿病管理，同时降低低血糖的风险，并最终提高生活质量。
Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.