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Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study

BACKGROUND: The management of type 2 diabetes mellitus in long-term care (LTC) settings can be complex as a result of age-related complications. Despite guideline recommendations, sliding scale insulin remains commonplace in the LTC setting and data on basal insulin use are lacking. METHODS: This re...

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Autores principales: Davis, Keith L, Wei, Wenhui, Meyers, Juliana L, Kilpatrick, Brett S, Pandya, Naushira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211864/
https://www.ncbi.nlm.nih.gov/pubmed/25364239
http://dx.doi.org/10.2147/CIA.S65411
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author Davis, Keith L
Wei, Wenhui
Meyers, Juliana L
Kilpatrick, Brett S
Pandya, Naushira
author_facet Davis, Keith L
Wei, Wenhui
Meyers, Juliana L
Kilpatrick, Brett S
Pandya, Naushira
author_sort Davis, Keith L
collection PubMed
description BACKGROUND: The management of type 2 diabetes mellitus in long-term care (LTC) settings can be complex as a result of age-related complications. Despite guideline recommendations, sliding scale insulin remains commonplace in the LTC setting and data on basal insulin use are lacking. METHODS: This retrospective study used medical chart data and the Minimum Data Set from elderly LTC facility patients who received basal insulin (insulin glargine, insulin detemir, or neutral protamine Hagedorn insulin) for the treatment of diabetes, to investigate the practice patterns and associated clinical outcomes. RESULTS: A total of 2,096 elderly, insulin-treated patients in LTC were identified, with 59.5% of them (N=1,247) receiving basal insulin. Of these, more than 50% of patients received sliding scale insulin in co-administration with basal insulin. Despite its ease of use, insulin pen use was very low, at 14.6%. Significant differences were observed between the basal insulin groups for glycated hemoglobin level and dosing frequency. Hypoglycemia was uncommon −17.2% of patients experienced at least one event, and there was no significant difference in the prevalence of hypoglycemia between the groups. CONCLUSION: These data suggest the underutilization of basal insulin in the LTC setting and worryingly high combinational use with sliding scale insulin. Differences in glycated hemoglobin and dosing frequencies between types of basal insulin warrant further comparative effectiveness studies.
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spelling pubmed-42118642014-10-31 Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study Davis, Keith L Wei, Wenhui Meyers, Juliana L Kilpatrick, Brett S Pandya, Naushira Clin Interv Aging Original Research BACKGROUND: The management of type 2 diabetes mellitus in long-term care (LTC) settings can be complex as a result of age-related complications. Despite guideline recommendations, sliding scale insulin remains commonplace in the LTC setting and data on basal insulin use are lacking. METHODS: This retrospective study used medical chart data and the Minimum Data Set from elderly LTC facility patients who received basal insulin (insulin glargine, insulin detemir, or neutral protamine Hagedorn insulin) for the treatment of diabetes, to investigate the practice patterns and associated clinical outcomes. RESULTS: A total of 2,096 elderly, insulin-treated patients in LTC were identified, with 59.5% of them (N=1,247) receiving basal insulin. Of these, more than 50% of patients received sliding scale insulin in co-administration with basal insulin. Despite its ease of use, insulin pen use was very low, at 14.6%. Significant differences were observed between the basal insulin groups for glycated hemoglobin level and dosing frequency. Hypoglycemia was uncommon −17.2% of patients experienced at least one event, and there was no significant difference in the prevalence of hypoglycemia between the groups. CONCLUSION: These data suggest the underutilization of basal insulin in the LTC setting and worryingly high combinational use with sliding scale insulin. Differences in glycated hemoglobin and dosing frequencies between types of basal insulin warrant further comparative effectiveness studies. Dove Medical Press 2014-10-23 /pmc/articles/PMC4211864/ /pubmed/25364239 http://dx.doi.org/10.2147/CIA.S65411 Text en © 2014 Davis et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Davis, Keith L
Wei, Wenhui
Meyers, Juliana L
Kilpatrick, Brett S
Pandya, Naushira
Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
title Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
title_full Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
title_fullStr Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
title_full_unstemmed Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
title_short Use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
title_sort use of basal insulin and the associated clinical outcomes among elderly nursing home residents with type 2 diabetes mellitus: a retrospective chart review study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211864/
https://www.ncbi.nlm.nih.gov/pubmed/25364239
http://dx.doi.org/10.2147/CIA.S65411
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