>>For Doctors >>March 2014

Patient Characteristics Associated with Poor Glycemic Control

A recent CDC report shows that 12.6% of adults with diabetes exhibit poor glycemic control.1  The authors state that the majority of adults with diabetes would benefit from reduction of A1c levels to ≤ 7%, and that an A1c level of 9% represents a modifiable, high level of risk that usually merits additional intervention.  When glycemic control is poor (A1c > 9%), diabetes levies additional health-care costs, higher risk of hospitalization / re-hospitalization, and high risk of disabling complications.  Poor glycemic control creates higher risk of diabetic retinopathy, chronic kidney disease, and cardiovascular disease.2-4  When you have homebound patients exhibiting poor glycemic control, please consider Ideal Home Care as a strong ally in your diabetes management plan.

People often think of a comprehensive diabetes management program as a service for the newly diagnosed.  However, the CDC report shows that, among people diagnosed with diabetes 10-15 years ago, the rate of poor glycemic control is 21.5%.  Recently observed poor glycemic control usually represents a need for skilled services regardless of the time since diagnosis.  When patients regularly receive their health care from a doctor’s office, the likelihood of poor glycemic control decreases (-13%).  When patients primarily receive their healthcare from a hospital / emergency department, the likelihood of poor glycemic control increases 79%.  This underscores the important role of discharge planning and emergency departments.  Ensuring a continuum of care post-discharge promises to improve morbidity and decrease the risk of hospitalization in the near future.  When patients are referred to Ideal Home Care, nurses will implement a disease management plan as well as work to make sure patients follow up with a doctor in the community.

For your homebound patients, Ideal Home Care can provide a number of services designed to improve your patient’s diabetes management.

Observation & Assessment: In situations where blood glucose levels or blood pressures begin fluctuating abnormally, it may be appropriate for doctors to order a home health episode.  Nurses can investigate compliance with special diets and reinforce teaching.  They can monitor blood pressure levels and report to the physician for medication changes.  They can assess the use of home equipment and make necessary changes.  Nurses can also teach diet and exercise intervention to better control fluctuating glucose levels.

Patient & Family Education: Effectively teaching geriatric patients sometimes requires repeated visits and a significant time investment.  You can trust Ideal Home Care to work diligently until your patients demonstrate the skills and knowledge necessary to manage their diabetes.  Teaching will include:

• Preparing & administering insulin injections
• Glucose monitoring
• Preparing & following a diabetic diet
• Observation of foot-care precautions
• Exercise intervention to control fluctuating glucose levels
• Observation & understanding s/s of hyper/hypoglycemia
• Resource coordination

 

References:

1. Dittmer D, Teasell R. Complications of immobilization and bed rest – Part 1: musculoskeletal and cardiovascular complications. Can Fam Physician. 1993; 39: 1428-1437.
2. Kortebein P, Ferrando A, Lombeida J, et al. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007; 297 (16): 1772-1774.
3. Brown C, Redden D, Flood K, et al. The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society. 2009; 57 (9): 1660-65.
4. Muller E. Influence of training and inactivity on muscle strength. Arch Phys Med Rehabil. 51: 449-62.