Spectrum of severity and control of diabetes mellitus in skilled nursing facilities

A descriptive and quality assessment study was made of 359 elderly patients with a diagnosis of diabetes mellitus in 39 Skilled Nursing Facilities (SNF) in upstate New York. The diagnostic prevalence of diabetes was about 12 percent--similar to that in a National Health Survey of nursing homes, but higher than that reported for the non-institutional elderly. Greater frequency and severity were observed among the females, but the median age for all the diabetic patients was about the same as that for the general SNF population. Several of the other disorders believed to be associated with diabetes were found to be of greater frequency in the SNF diabetic group, but some were not; also, inadequate control of diabetes was associated with some, but not all of these disorders. The severity of diabetes in this elderly SNF population with adult-onset diabetes was usually mild, with a low frequency of complications and of poor control. Problems arose with respect to the ascertainment and recording of diagnostic and control data, most often related to the responsibilities of the attending physicians. There were also problems of uncertainty as to the cause-and-effect relationship between thecontrol of blood glucose levels and treatment outcomes. The establishment of criteria and standards for medical care evaluation studies is discussed.