Potential Overtreatment and Undertreatment of Type 2 Diabetes Mellitus in Long-Term Care Facilities: A Systematic Review |
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| Institution: | 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia;3. Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia;4. Helping Hand Aged Care, North Adelaide, SA, Australia;5. University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia;6. Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia;1. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;2. Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy;3. Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy;4. Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy;1. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA;2. Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA;3. The Cecil G. Sheps Center for Health Services Research; School of Social Work; University of North Carolina at Chapel Hill, NC, USA;4. OHSU-PSU School of Public Health, Portland State University, Portland, OR, USA;5. Center for Health Policy Evaluation in Long-Term Care; American Health Care Association/National Center for Assisted Living, Washington, DC, USA;1. Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, Guangdong, China;2. National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China;3. Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China;1. Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan;2. Division of Rehabilitation, Kobe University Hospital, Kobe, Japan;3. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan;4. Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan;5. Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan |
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| Abstract: | ObjectiveTo investigate the prevalence, outcomes, and factors associated with potential glycemic overtreatment and undertreatment of type 2 diabetes mellitus (T2DM) in long-term care facilities (LTCFs).DesignSystematic review.Setting and ParticipantsResidents with T2DM and aged ≥60 years living in LTCFs.MeasuresArticles published between January 2000 and September 2020 were retrieved following a systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL plus, and gray literature. Inclusion criteria were the reporting of (1) potential overtreatment and undertreatment quantitatively defined (implicitly or explicitly) based on hemoglobin A1c (HbA1c) and/or blood glucose; (2) prevalence, outcomes, and associated factors of potential glycemic overtreatment and undertreatment; and (3) the study involved residents of LTCFs.ResultsFifteen studies were included. Prevalence of potential overtreatment (5%–86%, n = 15 studies) and undertreatment (1.4%–35%, n = 8 studies) varied widely among facilities and geographical locations, and according to definitions used. Prevalence of potential overtreatment was 16%–74% when defined as treatment with a glucose-lowering medication in a resident with ≥1 hypoglycemia risk factor or serious comorbidity, together with a HbA1c <7% (n = 10 studies). Potential undertreatment was commonly defined as residents on glucose-lowering medication having HbA1c >8.5% and the prevalence 1.4%–14.8% (n = 6 studies). No studies prospectively measured resident health outcomes from overtreatment and undertreatment. Potential overtreatment was positively associated with use of oral glucose-lowering medications, dementia diagnosis or dementia severity, and/or need for assistance with activities of daily living (n = 2 studies). Negative association was found between potential overtreatment and use of insulin/combined insulin and oral glucose-lowering medication. No studies reported factors associated with potential undertreatment.Conclusions and ImplicationsThe prevalence of potential glycemic overtreatment and undertreatment varied widely among residents with T2DM depending on the definition(s) used in each study. Longitudinal studies examining associations between glycemic management and health outcomes, and the use of consensus definitions of overtreatment and undertreatment are required to establish findings about actual glycemic overtreatment and undertreatment in LTCFs. |
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| Keywords: | Type 2 diabetes glycemic management overtreatment undertreatment hypoglycemia hyperglycemia long-term care nursing homes homes for the aged |
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