Diabetes in Long-Term Care Homes: An Educational Intervention to Optimize Diabetes Care in Frail Older Adults

Abstract

The prevalence of diabetes in Canadian long-term care (LTC) homes is approximately 25%. Registered nurses (RNs), registered practical nurses (RPNs) and personal support workers (PSWs) are essential diabetes care providers in LTC homes. Our primary objective was to evaluate an educational intervention's impact on comfort and knowledge of diabetes management among medical support staff in LTC homes. A pilot educational intervention in 2 LTC homes in Ontario, oriented toward PSWs, RN/RPNs and registered dieticians (RDs) was conducted. A diabetes self-assessment questionnaire and a knowledge test were administered before and after an educational seminar. Mean glycated hemoglobin (HbA1C) levels, type and doses of medication, and use of an insulin sliding scale before and after the intervention were measured at each home. Both groups demonstrated an overall increase in comfort with diabetes management and self-appraised knowledge of diabetes. Scores increased most in the domain of footcare for PSWs and insulin management for the RN/RPN/RD group (38% and 41%, respectively). The intervention resulted in an average increase in the number of residents with HbA1C levels within the recommended range for older adults, a decrease in both the use of an insulin sliding scale and the number of residents requiring renal-based dose reduction of diabetes medications. This pilot project was the first to evaluate an interdisciplinary educational intervention on diabetes management in LTC homes in Ontario, and overall improved confidence and diabetes knowledge among LTC health-care workers.