Using a mixed-methods convergent parallel design, this study surveyed medical directors and attending physicians of long-term care centres through an online questionnaire and one-on-one semistructured interviews.
A total of 39 questionnaires were completed, representing a variety of LTC settings, including private and public settings. Diabetes management practices varied across the participating settings with respect to glucose targets, with 69% of respondents selecting glycated hemoglobin levels of 8% or greater as being appropriate for LTC residents. Blood glucose monitoring, pharmacotherapy, presence of comorbidities, frailty and life expectancy were highlighted as variables for consideration in diabetes management in LTC. Interviews with attending physicians further illustrated the variability of opinions related to the use of clinical practice guidelines, glucose target levels and intensity of management (i.e. blood glucose monitoring and pharmacotherapy).
The findings of this study were triangulated with both the quantitative survey and the qualitative interviews. The implications of these findings suggest a disparity between what physicians feel should be achieved for diabetes management and what is actually done for frail elderly adults in LTC settings. Further research needs to be completed to assess the distinct needs and considerations of this unique population and healthcare setting.