| | With prior approval of the Human Subjects Committee of the Institutional Review Board of our institution, the patient and consultant pharmacists records for a 120-bed nursing home were retrospectively reviewed for the diagnosis and treatment outcomes of diabetes mellitus (DM) over a three-year period.
A group of 41 of the 233 patients (prevalence of 17.6%) who had been in residence for 1 to 36 months was identified as having a diagnosis of DM, and both demographic and treatment data gathered on the average of 20.8 months of length of stay DM treatment.
The 233 patients were predominantly white females with an average age of 83 years, with an average length of stay of 22 months.
The DM treatment group was further subdivided into four predominant treatment groups (number): oral hypoglycemics and diet (5), insulin and diet (25), diet alone (9), and no dietary or drug treatment (2).
Seven of 41 patients crossed over between groups during the study period.
All patients were further classified by weight variance from ideal body weight (IBW) from <> 20% over their IBW and by treatment groups.
Treatment outcomes were assessed by monthly fasting blood sugars (FBSs) as hypoglycemia (FBS <> 160mg/dl) and the presence of diabetic complications of amputation, decubitus/diabetic ulcers, high blood pressure, congestive heart failure, and ischemic coronary vessel disease were noted for all patients.
Diabetic complications and FBSs outside the acceptable FBS treatment range of 100-160mg/dl were predominantly in the insulin plus diet treatment group.
Statistical treatment of the variables of weight and FBSs found that hyperglycemic episodes were more common (27 of 30 episodes) in the overweight insulin group who did not comply with ADA diet nor lose weight.
Hypoglycemic reactions were most common in the underweight insulin group (17 of 24 episodes).
Hospitalization and death rates were compared for both DM and non-DM patients over the study period.
While there was no statistically significant difference in the percentage death rate (24.4 vs. 25.5) or percentage of patients hospitalized (60.9 vs. 60.1) there was significant difference in the rate of hospitalization per DM patient (2.84) vs. non-DM patients (1.82) who required hospitalization during their length of stay or study period.
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