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Objectives: Over 25% of nursing home residents have diabetes. Nurses (registered nurses and registered practical nurses), registered dietitians and personal support workers (PSWs) provide the bulk of diabetes care in long-term care (LTC) homes, but their self-rated diabetes knowledge is poor. In this study, we evaluated the impact of an educational intervention on comfort with, and knowledge of, diabetes management among frontline LTC staff., Methods: We implemented an educational intervention in 2 LTC homes in Ontario that targeted nurses and dietitians, PSWs and physicians. A self-assessment questionnaire and a knowledge test were administered to nurses and dietitians and PSWs before and after the intervention. We also measured pre- and postintervention glycated hemoglobin levels, use of sliding scale insulin and type and dose of diabetes medications prescribed., Results: After the intervention, both the nurses and dietitians and PSWs groups demonstrated increased comfort with diabetes management and improved self-appraised knowledge. Among PSWs, knowledge of foot care improved the most, and the nurses and dietitians group had the greatest improvement in knowledge of blood glucose monitoring. In addition, there was reduced use of sliding scale insulin, and in the number of residents requiring renal-based dose reductions of glucose-lowering medications. This intervention was innovative as it targeted different LTC health-care providers; it demonstrated the potential to increase LTC health-care providers' confidence in diabetes management. Future studies could assess the clinical benefits of an educational intervention on rates of hypoglycemia and improving A1C targets., Conclusions: An educational intervention can improve knowledge and comfort of diabetes management of frontline LTC staff., (Copyright © 2020. Published by Elsevier Inc.)

Background: Diabetes care in the long-term care (LTC) setting is complicated by increased prevalence of comorbidities, age-related changes in medication tolerance, frailty and limited resources. Registered nurses (RNs), registered practical nurses (RPNs) and personal support workers (PSWs) are responsible for front-line diabetes care; however, there is limited formal diabetes education in this setting., Purpose: The current study aimed to assess the knowledge confidence and desire for additional diabetes education among nurses and PSWs in the LTC setting., Methods: We studied 89 RNs, RPNs and PSWs (Mage=43.6, 94.3% female) in 2 LTC facilities in the Kitchener-Waterloo area who participated in an online survey assessing knowledge and confidence in 6 key areas of diabetes care (nutrition, insulin, oral medications, hypoglycemia, hyperglycemia and sick-day management). Interest in further diabetes education was also explored., Results: Self-rated knowledge and confidence were generally moderate to high, ranging from 46% to 79% being moderately to very knowledgeable and from 61% to 74% being moderately to very confident. Knowledge and confidence was highest for nutrition and management of hypo- and hyperglycemia and lower for sick-day management, oral medications and insulin. There were significant differences between clinicians such that PSWs reported less knowledge and confidence than RNs and RPNs on most parameters. Among the whole sample, 85% wanted education about diabetes, and this rate did not vary by occupation. The most commonly reported areas for additional education concerning diabetes were for management of hypo- and hyperglycemia (30% to 31%) and insulin (31%)., Conclusion: Overall, the findings indicate moderate levels of self-rated knowledge across diabetes care areas; however, most clinicians feel there is room for more diabetes-care education, particularly regarding insulin and management of hypo- and hyperglycemia., (Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objectives: There is limited evidence for the management of diabetes in frail elderly residents living in long-term care (LTC) settings. The purpose of this study was to explore the current practices of glycemic management in frail elderly persons with diabetes living in LTC settings., Methods: Using a mixed-methods convergent parallel design, this study surveyed medical directors and attending physicians of long-term care centres through an online questionnaire and one-on-one semistructured interviews., Results: A total of 39 questionnaires were completed, representing a variety of LTC settings, including private and public settings. Diabetes management practices varied across the participating settings with respect to glucose targets, with 69% of respondents selecting glycated hemoglobin levels of 8% or greater as being appropriate for LTC residents. Blood glucose monitoring, pharmacotherapy, presence of comorbidities, frailty and life expectancy were highlighted as variables for consideration in diabetes management in LTC. Interviews with attending physicians further illustrated the variability of opinions related to the use of clinical practice guidelines, glucose target levels and intensity of management (i.e. blood glucose monitoring and pharmacotherapy)., Conclusions: The findings of this study were triangulated with both the quantitative survey and the qualitative interviews. The implications of these findings suggest a disparity between what physicians feel should be achieved for diabetes management and what is actually done for frail elderly adults in LTC settings. Further research needs to be completed to assess the distinct needs and considerations of this unique population and healthcare setting., (Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objectives: Physicians lack clear guidance about adaptation of clinical practice guidelines for elderly institutionalized patients with diabetes. In a large long-term care facility, a diabetes management flow sheet was trialed to determine which clinical parameters were found useful by clinicians in the management of diabetes in that setting., Methods: Clinical practice guidelines for diabetes management were reviewed with attending physicians. Diabetes management flow sheets were distributed for all patients coded as having diabetes on their most recent minimum data sets. After a period of 14 months, flow sheet completion rates were ascertained and physicians were surveyed regarding the utility of the flow sheet., Results: Initial flow sheet data were completed in full or in part for only 57% of the 121 study subjects; 39% of the subjects died within 14 months. Quarterly follow-up data were completed for 58% of the flow sheets., Conclusions: The diabetes management flow sheet was not found to be useful by attending physicians as a chronic-disease management tool., (Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objective: We aimed to describe trends in the prevalence and incidence of diabetes mellitus and also report the overall use of diabetes medications among patients newly admitted to a long-term care facility (LTCF)., Methods: A retrospective cohort study was done using health administrative databases in Saskatchewan. Eligible patients were newly admitted to LTCF in Saskatchewan between 2003 and 2011 and maintained LTCF residency for at least 6 months. Prevalence of diabetes was defined with physician or hospital claims in the 2 years preceding admission. Antihyperglycemic medication use was estimated from prescription claims data during the first 6 months after LTCF admission. All data were descriptively analyzed., Results: The validated case definition for diabetes (≥2 diagnostic claims) in the 2 years before or 6 months after admission was met by 16.9% of patients (2471 of 14,624). An additional 965 patients (6.6%) had a single diabetes diagnostic claim or antihyperglycemic prescriptions only. Among patients receiving antihyperglycemic therapies, 64.9% (1518 of 2338) were exclusively managed with oral medications, and metformin was the most commonly used medication. Glyburide was commonly withdrawn after LTCF admission. Insulin use was observed in 23.9% of diabetes patients, with a mean daily average consumption of 54.7 units per day., Conclusions: Use of diabetes medications appear to generally align with Canadian practice recommendations as evidenced by declining use of glyburide and frequent use of metformin. Future studies should examine clinical benefits and safety of hypoglycemic agent use in LTCFs., (Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objective: Increasing numbers of elderly people in long-term care have diabetes mellitus. We explored nurses' perceptions and level of comfort with current diabetes management of patients in long-term care., Methods: A mixed-methods approach using a cross-sectional survey design, including both quantitative and open-ended questions, was used. The licensed nurses employed in 9 long-term care homes in southwestern Ontario were surveyed. The survey explored nurses' comfort with managing diabetes, detecting hypoglycemia and hyperglycemia, glucose monitoring guidelines, and insulin administration and training., Results: Of 301 nurses invited (130 registered nurses [RNs], 171 registered practical nurses [RPNs]), 165 nurses (77 RNs and 88 RPNs) responded (165 of 280, 59% response rate). Nurses were female (93.3%); their mean age was 45.3 years (SD 11.7). Most noted that the medication administration system and guidelines regarding diabetes management were adequate; RPNs were more comfortable administering insulin than RNs (p=0.048)., Conclusions: The findings suggest RNs and RPNs have different comfort levels and perceptions of diabetes management., (Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)