Our Mission

Dialog Healthcare is proudly committed to our goal of assisting LTC Facilities in achieving excellence in Diabetes Care.



Diabetes in America

Position Statement of the American Diabetes Association (Diabetes Care 2016; 39:308-318)

The epidemic growth of type 2 diabetes in the U.S. has disproportionately affected the elderly. In the long-term care (LTC) population, the prevalence of diabetes ranges from 25% to 34% across multiple studies. Diabetes not only increases the risk of cardiovascular and microvascular complications but also increases the risk of common geriatric syndromes, including cognitive impairment, depression, falls, polypharmacy, persistent pain, and urinary incontinence.

Establishing the goals of care and management strategies for an individual in the LTC setting are complex and require individualized approach based on unique characteristics of each patient. Severe hypoglycemia may have catastrophic consequences in elderly patients and should be carefully avoided. Persistent hyperglycemia increases the risk of dehydration, electrolyte abnormalities, urinary incontinence, dizziness, falls, and hyperglycemic hyperosmolar syndrome, infection, poor wound healing, and hospital readmission.

The clinical complexity and psychosocial heterogeneity of the older population in LTC facilities require innovative thinking and individualized strategies to care for them.

Patients admitted to LTC facilities are typically seen by a medical provider at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. In practice, patients are seen within the first week of admission and when medically necessary (although this may be several days after an event or change of condition). This system means that patients may have uncontrolled blood glucose levels or wide excursions without the practitioner being notified.

Challenges specific to staff and practitioners include multiple changing treatment approaches, lack of team communication, excessive reliance on SSI, inappropriate dosing or timing of insulin, knowledge deficits, lack of comfort with new insulin and injectable agents, failure of timely stepwise advance in therapy, failure to individualize care, and therapeutic nihilism.

It requires a dedicated interprofessional team composed of registered nurses, certified nursing assistants, diabetes educators, dietitians, food service managers, consultant pharmacists, physical therapists, social workers, and practitioners to manage older patients with diabetes in LTC facilities.