June 8, 2007
By Jared Rutecki
Ohio University College of Osteopathic Medicine researchers have found that elderly patients with type 1 and type 2 diabetes living in nursing homes often fail to get care that meets American Diabetes Association standards. The results of their study are in this month's issue of the journal Diabetes Care and have been picked up by national media outlets such as The Washington Post and Forbes.
"Our study is based on the principle that there are guidelines on how to manage diabetes for the outpatient adult, and there are new guidelines for how to manage diabetes for patients in the hospital, but there are no guidelines for treating people in nursing homes," said Jay Shubrook, D.O., assistant professor of family medicine at OU-COM and one of the study's authors.
Shubrook and his co-authors, Frank Schwartz, M.D., assistant professor of endocrinology, and second-year medical student Rachel Holt, examined the care of 108 diabetic patients at 11 extended health-care facilities in Ohio and West Virginia over a one-year period.
According to the study, only 38 percent of the patients monitored met blood glucose (sugar) goals, and only 55 percent had satisfactory blood pressure levels. Only 31 percent of patients had lipids (serum total cholesterol) checked yearly, and of those, only 58 percent had acceptable levels.
According to Holt, the data revealed the lack of a systematic approach to diabetes treatment in the facilities studied. The findings demonstrate that practice guidelines for nursing home patients must be developed in order to offer optimal care.
The study also reports that diabetes is expected to increase 336 percent by 2050, and this will produce an enormous economic burden. "The fastest growing population of young people with diabetes is in this region," Holt said of Appalachia. "Imagine the implications of this."
Appalachia has two to three times the national incidence of diabetes, so the long-term implication is that the number of elderly diabetics in nursing homes in the region will also increase.
Based on their findings, Shubrook and Schwartz are now developing treatment protocols for diabetes care in nursing homes. These protocols will be offered to medical directors of these extended care facilities in order to improve the quality and consistency of patient care.
Phase two of the study, which gets under way later this year, includes a second review of patients' charts to determine if following the treatment protocols proposed by Shubrook and Schwartz results in improved quality of life for the residents.