Pragmatic Innovations in Post-Acute and Long-Term Care Medicine Feasible new, practical products or approaches intended to improve outcomes or processes in post-acute or long-term care| Volume 22, ISSUE 6, P1322-1326.e2, June 2021

A Successful Diabetes Management Model of Care in Long-Term Care Facilities

Published:August 02, 2020DOI:


      The management of diabetes in long-term care (LTC) facilities requires facility staff to perform most self-care activities on the behalf of the residents. A practical model of care to improve diabetes management was developed and implemented at 6 LTC facilities in the Northeast United States between 2009 and 2012. The components of the program included (1) developing an individualized education curriculum and educating LTC interdisciplinary staff; (2) educating patients and caregivers; and (3) developing a clinical care algorithm. Over 500 staff members were educated and achieved competence. There were 1031 residents screened for risk of hypo- or hyperglycemia on admission, and 245 residents (24%) experienced hypoglycemia and 240 residents (23%) experienced hyperglycemia. Hypoglycemia episodes resolved without recurrence in 73%-90% cases because of interventions initiated by LTC staff. The implementation of a practical model of diabetes management in LTC facilities can improve staff education and lead to improved diabetes management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Travis S.S.
        • Buchanan R.J.
        • Wang S.
        • Kim M.
        Analyses of nursing home residents with diabetes at admission.
        J Am Med Dir Assoc. 2004; 5: 320-327
        • Neuwahl S.
        • Honeycutt A.A.
        • Poehler D.C.
        • et al.
        Diabetes-attributable nursing home costs for each U.S. state.
        Diabetes Care. 2018; 41: 1455-1461
        • Lekarcyk J.A.
        • Himmel L.
        • Munshi M.
        Blood glucose monitoring and underlying question of hypoglycemia are both essential to preventing hypoglycemia in nursing home residents.
        Clin Diabetes. 2013; 31: 28-30
        • Munshi M.N.
        • Florez H.
        • Huang E.S.
        • et al.
        Management of diabetes in long-term care and skilled nursing facilities: A position statement of the American Diabetes Association.
        Diabetes Care. 2016; 39: 308-318
        • LeRoith D.
        • Biessels G.J.
        • Braithwaite S.S.
        • et al.
        Treatment of diabetes in older adults: An endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2019; 104: 1520-1574
        • Meneilly G.S.
        • Knip A.
        • Miller D.B.
        • et al.
        2018 Clinical practice guidelines: Diabetes in older people.
        Can J Diabetes. 2018; 42: S283-S295
        • Sinclair A.J.
        • Gadsby R.
        • Abdelhafiz A.
        • Kennedy M.
        Failing to meet the needs of generations of care home residents with diabetes: A review of the literature and call for action.
        Diabetes Med. 2018; 35: 1144-1156
        • Munshi M.
        • Blair E.
        • Ganda O.
        • Gabbay R.A.
        • members of the Joslin Guidelines Committee
        Guideline for the care of the older adults with diabetes.
        Am J Manag Care. 2018; 24: 240-252
        • Vincent C.
        • Hall P.
        • Ebsary S.
        • et al.
        Knowledge Confidence and desire for further diabetes-management education among nurses and personal support workers in long-term care.
        Can J Diabetes. 2016; 40: 226-233
        • Bouchonville M.F.
        • Hager B.W.
        • Kirk J.B.
        • et al.
        Endo Echo improves primary care provider and community health worker self-efficacy in complex diabetes management in medically underserved communities.
        Endocr Pract. 2018; 24: 40-46