Background: There are significant research gaps concerning the management of diabetic patients in long-term geriatric care, those afflicted by chronic diseases, disability and frailty. Under the principle of mitigating hyperglycemia and preventing hypoglycemia we compared two modalities of glycemia treatment for insulin dependent diabetic residents in geriatric hospital care.
Population and Methods: Eligible for this study were 30 out of 58 diabetic patients, residing in two departments of comprehensive geriatric care and two departments of prolonged mechanical ventilation. Point of care capillary glycemia was assessed 4 times daily. Two consecutive 14-day periods were designated to assess the quality of glycemia control. In the first period, the physicians' intuitively chosen glycemia goals were applied; in the second period, numerical upper and lower glycemia targets were set and applied in treatment. Two independent observers reviewed the data in retrospect. For both study periods, point of care glycemia was qualified with reference to glycemic upper and lower targets as specified for the second study period.
Results: The patients' ages ranged 64 - 82 years. Both genders were equally represented. The length of residency in our institution ranged between 4 months and 5 years. All patients were diagnosed with frailty of moderate or severe degree. Besides diabetes mellitus, most patients had two or more chronic diseases. All patients were moderately to severely frail. The patients' mean HbA1c on study entry was 7.2%. The studies' main outcome measures were “glycemia high”, that means exceeding the decided target, and hypoglycemia. In study phase 1 the percent of "glycemia high” tests was near 30% in two departments, and near 10% in other two departments. The percentage "glycemia high" was unchanged during study phase 2 or decreased insignificantly. There was one hypoglycemic event during the study.
Conclusion: A matter of potential practical importance, we probed whether treatment according to strict upper and lower glycemia targets may produce better results than usual by physician intuitively chosen glycemia goals. Under the shared principle of tailoring glycemia to frailty severity, the two models of treatment produced similar results. Future studies comparing the two models of management might overcome some limitations of the present investigation: small patient population, short study period, and retrospective analysis of data.