Are older patients with diabetes still being overtreated in french long-term care homes?

Abstract

Background Diabetes management has not been evaluated in French nursing homes (NHs) for 10 years. Objectives The present study aimed to compare the management of diabetes with guidelines in older patients living in NHs. Design Observational, retrospective and multicentre study carried out in 13 NH in the Cote d’Or region of France. Settings and subjects Between January and June 2018, all NH residents older than 65 years and known to have diabetes (n = 148) were included. Methods Epidemiological, clinical and biological data and diabetes characteristics were collected from the medical records. Results The average glycated haemoglobin (HbA1C) was 7.2 ± 1.2%. In total, 51% of patients had HbA1C < 7% (n = 70), of which 39 took one or more antidiabetic drugs. In total, 28 of those patients (40%) were at risk of developing hypoglycaemia as a result of their treatment. In all, 44.6% of patients were treated with insulin. Glinides were the most commonly prescribed oral antidiabetic drug (OAD) (27%). Capillary blood glucose monitoring (CBGM) was not carried out daily for 75% of patients taking a potentially hypoglycaemia-inducing OAD. Conclusions We found that glycaemic control was too tight in at least 36.5% of the total population and that 40% of patients with HbA1C < 7% were potentially overtreated. The use of dipeptidyl peptidase 4 (DPP-4) inhibitors was still insufficient, as was CBGM. Avoiding hypoglycaemia is one of the priorities in the management of older patients with diabetes. Therefore, NHs should focus on improving the use of glycaemic targets and antidiabetic drugs that do not induce hypoglycaemia, as well as better monitoring of capillary blood glucose.