AMDA Foundation - Research Network Study Offers Insights into Diabetes Management

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Vol XIX, Nov `05

Research Network Study Offers Insights into Diabetes Management

Vol XIX, November `05

Results from a survey of Research Network members and other physicians provide insights into how practitioners address diabetes management in their long term care facilities. "We found that physicians tailored or varied the intensity of diabetes management depending on patient status," said Naushira Pandya, MD, CMD, one of the physicians involved in the study. The survey stemmed from the work of the Research Network's diabetes workgroup.

The study went out to 683 nursing facility physicians who are Research Network and/or AMDA members and presented three model patients: one who was cognitively intact and functionally impaired, one cognitively impaired but functionally intact, and one impaired both cognitively and functionally. The study produced a 37% response rate.

The study posed a number of specific questions, including:

Do you order a special or diabetic diet?
What do you consider acceptable blood sugars?
Do you monitor basic chemistry panels?
Do you order routine podiatry care?

For every question, respondents were asked to answer "always," "sometimes," or "never" based on each patient profile. "We discovered there is a highly significant variability in management for the different profiles. Functionally and cognitively impaired patients were less likely to receive a special diet, have lipids monitoring, or have routine ophthalmology checkups," said Pandya. More aggressive treatment seems to be reserved for more functionally and/or cognitively intact patients. However, she added, there was no significant variability between the profiles in terms of diabetes medications.

Pandya noted that physicians indicated that they address diabetes on a case-by-case basis. "This possibly involves discussions with family members and others on the interdisciplinary team, but we don't know this from the survey," she explained.

The study results back-up much of what is stated in AMDA's clinical practice guideline on diabetes. For example, the CPG does not recommend implementing a diabetic diet for nursing facility patients; and survey respondents indicated that they agree. "There is no such thing as a diabetic diet anymore," observed Pandya. "Instead, each meal should have a fixed amount of carbohydrates."

Study leader Matt McNabney, MD, and his team have submitted their survey findings to the Journal of the American Medical Directors Association, and the article is expected to be published next year.