Are elderly patients with diabetes being overtreated in French long-term-care homes?

In France, diabetes prevalence and ageing of the population are both on the increase, yet little information on diabetes in elderly patients living in geriatric institutions is available. Moreover, institutionalized diabetic patients are not included in the French recommendations for the management of diabetes in the elderly. For this reason, the aim of the present study was to evaluate diabetes management in older, institutionalized patients.

The medical records of 100 diabetic patients, aged 65 years and over, and living in seven geriatric institutions in the Côte d'Or region of France, were studied from May 2008 to January 2009.

Prevalence of diabetes in these seven geriatric institutions was 15.46±4.9%, higher than in the general population. The diabetic patients had a mean age of 81.85±11.93 years, and 32% had glycated haemoglobin (HbA(1c)) less or equal to 6.5%, indicating a high risk of severe hypoglycaemia. A diet for diabetes was prescribed in 54% of the patients, but HbA(1c) levels did not differ between patients following and not following the diet (7.26±1.36% vs 7.11±1.10%, respectively; P=0.27). Creatinine was assessed in 87% of the patients, and 16% were ophthalmologically followed-up. Daily capillary blood glucose monitoring was performed in 100% of the patients taking insulin and in 17% of those taking oral antidiabetic treatment (P<0.0001).

Our data show that, among older institutionalized patients, the prevalence of diabetes is high and the control of diabetes too tight, with a potential risk of hypoglycaemia. Antidiabetic treatment should be reduced when the HbA(1c) value is less than 7.5% in this frail and functionally dependent population. Furthermore, a diabetic diet, prescribed for more than half this population, is useless for glycaemic control and may even impinge on quality of life.