SAN FRANCISCO – The prevalence of diabetes mellitus in a study of 2,317 U.S. nursing home residents was 33%, higher than previous reports that pegged the prevalence at 11%-27% of nursing home residents.
Previous estimates predominantly relied on the Minimum Data Set, a standardized instrument used by all U.S. nursing homes that includes diabetes among 400 items assessed in each resident. The current retrospective study incorporated the Minimum Data Set plus an audit of medical charts and a review of pharmacy data on antidiabetic medications prescribed for residents, Sandra Molotsky reported in a poster presentation at the annual meeting of the Gerontological Society of America.
The study looked at residents aged 65 years or older in 23 randomly selected nursing homes who were neither receiving hospice care nor in persistent vegetative states. The study population had a mean age of 83 years and had been living in nursing homes for a mean of 3 years. Overall, 73% of participants were female and 84% were white.
Compared with the cohort as a whole, residents with diabetes were significantly more likely to be younger than 84 years, male (38% vs. 27% overall), and obese (48% vs. 22% overall). Of the 9% of residents who were Hispanic, 46% had diabetes; similarly, of the 7% of residents who were black, 40% had diabetes, said Ms. Molotsky, director of Omnicare Senior Health Outcomes LLC, King of Prussia, Pa. The company is a research division of Omnicare Inc., which provides pharmacy services in nursing homes. The study was funded by Sanofi-Aventis, which markets medications for diabetes.
The diabetic residents carried significantly more comorbid illnesses. Medical chart reviews found significantly higher rates of chronic renal insufficiency (10%) and dyslipidemia (15%) in residents with diabetes, compared with rates of renal insufficiency (5%) and dyslipidemia (8%) in nondiabetic residents, she and her associates reported.
Minimum Data Set results suggested no difference between groups in the rate of renal failure, but chart reviews found evidence of renal failure in a significantly higher proportion of diabetic (6%) than nondiabetic (2%) residents. The study also found trends for higher rates of neuropathy, peripheral neuropathy, or gastroparesis in diabetic residents, but these trends did not reach statistical significance.
Diabetic residents were 64% more likely to be hospitalized within 6 months of the start of the analysis, compared with nondiabetic residents. Also within that 6-month window, residents with diabetes were more likely to develop infection (18%) or have a cerebrovascular accident (27%), compared with nondiabetic residents, 11% of whom developed infections and 17% of whom had cerebrovascular accidents.
A large proportion of diabetic residents were on medications for comorbid disorders. They were twice as likely as nondiabetic residents to be taking ACE inhibitors, angiotensin II receptor blockers, and statins.
The prevalence of diabetes in U.S. adults aged 65 years or older is expected to increase by 56% in the coming years, which would mean 7.5 million older Americans with diabetes in 2020. “Management of diabetes mellitus in skilled nursing facilities will be an important aspect of resident management to reduce comorbidity and mortality,” the investigators concluded.
Data obtained in the analysis but not reported in the poster showed evidence of appropriate monitoring and treatment in 70% of residents with diabetes, Ms. Molotsky said. For the other 30%, “We didn't have hemoglobin A1c values. We didn't have any fasting blood glucose levels. There wasn't evidence of any monitoring whatsoever in the chart,” she said.