Individualizing Treatment for Nursing Home Residents with Diabetes Mellitus

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DESCRIPTION (provided by applicant): Rationale: Diabetes mellitus (DM) is becoming increasingly common in the nursing home (NH) population. However, there is great uncertainty about the optimal level of glycemic control for NH residents with DM. Our broad objective is to develop an evidence base to individualize and improve the care for NH residents with DM. Research Aims: Our aims are to (1) determine the current practices for blood sugar control in a national sample of veterans affairs (VA) NHs, (2) determine whether the level of glycemic control is associated with geriatric outcomes such as incontinence and falls and (3) explore the goals of treatment and preferences of individual NH residents regarding treatments (e.g. insulin) and outcomes. Career Objectives/Aims: These projects will allow the PI to develop expertise (1) using electronic medical record data for clinical research and (2) performing qualitative research eliciting patient values and preferences. Research Design/Methods: For Aims 1 and 2, we will obtain laboratory, pharmacy and outcomes data for all VA NHs. We will determine current practices by determining the proportion of VA NH residents with diabetes who are getting specific treatments (e.g. insulin or oral medications) and direct complications (e.g. hypoglycemia). We will then determine whether complications and geriatric outcomes are associated with HbA1c levels, stratified by treatment. For Aim 3, we will conduct semi-structured interviews with residents of the San Francisco VA NH and the Jewish Home of San Francisco to elicit their values and preferences regarding DM treatments and outcomes. Relevance to Public Health: By determining the current practices and the relationship between the level of blood sugar control and geriatric outcomes such as incontinence, we will provide information for patients and clinicians so that they can make individualized decisions about diabetes care in the NH. Further, by highlighting relationships and common patient preferences, our work will obtain data to support future studies implementing tools to promote individualized decision making for NH residents with diabetes.