Do Frequent Fingersticks Improve Glycemic Control in Nursing Home Diabetic Patients?

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.