TABLE 1.
Clinical Challenges and Strategies for Diabetes Care in LTC Settings (3)
| Comorbidity/Geriatric Syndrome | Consequences | Management Strategies |
|---|---|---|
| Delirium or progressive cognitive decline | • Irregular meal intake | • Simplified medication regimen |
| • Refusal of glucose monitoring | • Block glucose testing | |
| • Refusal of medications or injections | • Deintensification of treatment | |
| • Avoidance of hypoglycemia | ||
| • Regular diet, preferred foods | ||
| Frailty and/or decreased mobility | • Deconditioning | • Optimized activity (seated, pedaling) |
| • Pressure ulcers | • Repositioning if mobility is impaired, to avoid pressure ulcers | |
| • Required assistance with feeding and toileting | • Assessment and treatment of pressure ulcers | |
| • Falls | • Nutrition consultation | |
| • Physical and occupational therapy | ||
| Depression | • Weight loss or gain | • Physical and social activities |
| • Refusal of activities and glucose monitoring | • Psychological counseling | |
| • Assess and treat depression | ||
| Skin infections, foot problems, nonhealing ulcers | • Hyperglycemia | • Increased glucose monitoring |
| • Poor intake, weight loss | • Increased diabetes medications | |
| • Impaired mobility | • Nutrition consultation | |
| • Regular skin checks and foot exams |