Sliding-Scale Insulin Use in Long-Term Care: An Updated Perspective

Area of Science:

• Geriatrics
• Endocrinology
• Pharmacology

Background:

• Diabetes Mellitus affects a significant portion of the elderly population, particularly those in long-term care facilities.
• Sliding-scale insulin (SSI) is a common insulin regimen for managing hyperglycemia in these patients.
• SSI has been identified on the Beers Criteria as a potentially inappropriate medication.

Purpose of the Study:

• To review recent guideline updates concerning the use of sliding-scale insulin (SSI)-only regimens.
• To provide insights into current recommendations for elderly patients with diabetes in long-term care settings.
• To highlight the shift away from SSI as a sole long-term diabetes management strategy.

Main Methods:

• Literature review of updated guidelines from key organizations.
• Analysis of recommendations from the Centers for Medicare & Medicaid Services, Beers Criteria, American Medical Directors Association, and American Diabetes Association.
• Synthesis of information regarding the appropriateness of SSI-only insulin regimens.

Main Results:

• Multiple guidelines, including the American Diabetes Association, do not recommend SSI-only regimens for long-term diabetes management.
• The Beers Criteria continue to list SSI as a potentially inappropriate medication.
• There is a growing consensus among healthcare stakeholders to move beyond SSI-only approaches.

Conclusions:

• Current evidence and updated guidelines increasingly discourage the sole use of sliding-scale insulin for elderly patients in long-term care.
• Alternative, more proactive insulin management strategies are recommended.
• Healthcare providers should adhere to updated guidelines to ensure optimal diabetes care for older adults in long-term care.