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Abstract #148952

Steve Hom, MD¹, Barbara C. Tommasulo, MD, CMD, LNHA², Avinash Singavarapu, MD³, Joshua Vernatter, MD³, Gweneth Francis, MD⁴, Charles Cal, RN, MS, MBA⁵, Roshan Hussain, MPH⁶, Gisele Wolf-Klein, MD¹, and Yosef Dlugacz, PhD⁶. (1) Geriatrics, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, (2) Cold Spring Hills Center for Nursing & Rehabilitation, 378 Syosset-Woodbury Road, Woodbury, NY 11797, (3) Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, (4) New York College of Osteopathic Medicine, Northern Blvd., Old Westbury, NY 11568-8000, (5) Suite 220B, 600 Northern Blvd, 600 Northern Blvd, Suite 220B, Great Neck, NY 11021, (6) The Krasnoff Quality Management Institute, 600 Northern Boulevard, Suite 220B, Great Neck, NY 11021, (516) 465-8417, rhussain@nshs.edu

Objective: Diabetes is a significant source of morbidity/mortality. It affects 26% of elderly nursing home residents. Yet, most glycemic control studies focus on younger patients. Clinical evidence supports optimal frequency of glucose monitoring in nursing homes, particularly in the presence of a stable HbA1c. This study explores the correlation of fingerstick frequency and glycemic control in long-term care diabetic patients. Methodology: A retrospective chart review of diabetic elderly patients (N=62), residing in a 672-bed facility for over one year, was performed. Demographics, HbA1c and fingerstick values over the preceding 6 months, changes in the diabetic drug regimens, and the presence of episodic hypo/hyperglycemia were obtained. The nutrition-related variables (i.e., weight, BMI, food supplements, and self-feeding ability) and presence of depression were also extracted. Results: The average age was 78.9 (65-97). Majority were female (74%), demented (77%), being treated for depression (61%) and most (84%) were on oral hypoglycemics. They received, on average, 34 fingersticks/month (range: 0-97/month). Some (23%) received insulin. Half (54%) had orders for insulin coverage. While 56% received food supplements, 36% required assistance for feeding and there was no significant change in weight/BMI. HbA1c improved in 48% of patients and worsened in 34%. However, there was no significant relationship between fingerstick frequency and glycemic control (p=.104). Conclusions: Frequent fingerstick monitoring did not improve glycemic control, suggesting a routinization of nursing/medical practice of elderly diabetics. In view of the cost, burden and quality of life issues related to close monitoring, routinization is a deficit to the diabetic elderly patients.

Learning Objectives:

• Assess the impact of diabetes on the Elderly Nursing Home Population.
• Describe the relationship of frequent fingersticks and glycemic control in the elderly nursing home population.
• Articulate the impact of rountiztion of nursing/medical practice on the elderly diabetic population.

Keywords: Diabetes, Long-Term Care

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.