Recent Study of Nursing Home Residents with Type 2 Diabetes – Overtreatment 

Mary Madison, RN, RAC-CT, CDP 
Clinical Consultant – Briggs Healthcare

The February 2022 Journal of the American Geriatrics Society (JAGS) provides information on Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.

“Nursing home (NH) residents with diabetes represent a large, growing population at high-risk for adverse events from glucose-lowering medications (GLMs). Approximately 1.3 million adults resided in an NH in 2016; an estimated 25%–34% of these NH residents have diabetes. Despite the large and growing numbers of NH residents with diabetes, little is known about GLM prescribing and deprescribing practices in this population.

Clinical guidelines from the American Diabetes Association, American Geriatrics Society, and Veterans Affairs (VA) recommend less aggressive glycemic treatment for frail older adults and NH residents as overly tight glycemic control can lead to substantial harms. Given the lack of benefit for macrovascular outcomes, the long time to benefit for tight glycemic control to decrease microvascular complications and the documented harms of tight glycemic control, guidelines generally recommend hemoglobin A1c (HbA1c) treatment targets from 7.5% to 9% in this population, and that glycemic goals in older frail adults should reflect patient preferences, comorbidity burden, life expectancy and minimize the risk of hypoglycemia. The 2021 American Diabetes Association guidelines for the treatment of diabetes in older adults have new emphasis on the importance of deintensification and deprescribing, noting that among long-term care NH residents, deintensification of high hypoglycemic risk agents is essential as there is no benefit of tight glycemic control in this population. In addition, deintensification and deprescribing may avoid harms (such as hypoglycemia) and burdens (such as the need for frequent fingerstick monitoring) leading to an improved quality of life.”

This is an interesting read.  I encourage you to share it with your Medical Director as well as your clinical team and colleagues.