Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
J Am Geriatr Soc. 2021 Feb;69(2):424-431. doi: 10.1111/jgs.16880. Epub 2020 Oct 16.
BACKGROUND/OBJECTIVE: Guidelines recommend less intensive glycemic treatment and less frequent glucose monitoring for nursing home (NH) residents. However, little is known about the frequency of fingerstick (FS) glucose monitoring in this population. Our objective was to examine the frequency of FS glucose monitoring in Veterans Affairs (VA) NH residents with diabetes mellitus, type II (T2DM).
National retrospective cohort study in 140 VA NHs.
NH residents with T2DM and older than 65 years admitted to VA NHs between 2013 and 2015 following discharge from a VA hospital.
NH residents were classified into five groups based on their highest hypoglycemia risk glucose-lowering medication (GLM) each day: no GLMs; metformin only; sulfonylureas; long-acting insulin; and any short-acting insulin. Our outcome was a daily count of FS measurements.
Among 17,474 VA NH residents, mean age was 76 (standard deviation (SD) = 8) years and mean hemoglobin A1c was 7.6% (SD = 1.5%). On day 1 after NH admission, 49% of NH residents were on short-acting insulin, decreasing slightly to 43% at day 90. Overall, NH residents had an average of 1.9 (95% confidence interval (CI) = 1.8-1.9) FS measurements on NH day 1, decreasing to 1.4 (95% CI = 1.3-1.4) by day 90. NH residents on short-acting insulin had the most frequent FS measurements, with 3.0 measurements (95% CI = 2.9-3.0) on day 1, decreasing to 2.6 measurements (95% CI = 2.5-2.7) by day 90. Less frequent FS measurements were seen for NH residents receiving long-acting insulin (2.1 (95% CI = 2.0-2.2) on day 1) and sulfonylureas (1.7 (95% CI = 1.5-1.8) on day 1). Even NH residents on metformin monotherapy had 1.1 (95% CI = 1.1-1.2) measurements on day 1, decreasing to 0.5 (95% CI = 0.4-0.6) measurements on day 90.
Although guidelines recommend less frequent glucose monitoring for NH residents, we found that many VA NH residents receive frequent FS monitoring. Given the uncertain benefits and potential for substantial patient burdens and harms, our results suggest decreasing FS monitoring may be warranted for many low hypoglycemia risk NH residents.
背景/目的：指南建议对疗养院（NH）居民进行血糖控制强度更低和监测频率更低的血糖治疗。然而，对于这一人群的指尖血糖监测频率，我们知之甚少。我们的目的是检测 VA 疗养院中患有 2 型糖尿病（T2DM）的 NH 居民的指尖血糖监测频率。
在 140 家 VA NH 中进行的全国性回顾性队列研究。
在从 VA 医院出院后于 2013 年至 2015 年期间入住 VA NH 的 T2DM 且年龄大于 65 岁的 NH 居民。
根据他们每天最高低血糖风险的降血糖药物（GLM），将 NH 居民分为五组：无 GLM；仅使用二甲双胍；使用磺酰脲类药物；使用长效胰岛素；以及任何使用短效胰岛素。我们的结局是每日指尖血糖测量次数。
在 17474 名 VA NH 居民中，平均年龄为 76 岁（标准差（SD）= 8 岁），平均糖化血红蛋白为 7.6%（SD = 1.5%）。在 NH 入住的第 1 天，49%的 NH 居民使用短效胰岛素，第 90 天略有下降至 43%。总体而言，NH 居民在 NH 入住第 1 天平均有 1.9 次（95%置信区间（CI）= 1.8-1.9）指尖血糖测量，第 90 天降至 1.4 次（95%CI = 1.3-1.4）。使用短效胰岛素的 NH 居民指尖血糖测量次数最多，第 1 天有 3.0 次（95%CI = 2.9-3.0），第 90 天降至 2.6 次（95%CI = 2.5-2.7）。接受长效胰岛素（第 1 天 2.1 次（95%CI = 2.0-2.2））和磺酰脲类药物（第 1 天 1.7 次（95%CI = 1.5-1.8））的 NH 居民的指尖血糖测量次数较少。即使是仅接受二甲双胍单药治疗的 NH 居民，第 1 天也有 1.1 次（95%CI = 1.1-1.2）指尖血糖测量，第 90 天降至 0.5 次（95%CI = 0.4-0.6）。
尽管指南建议对 NH 居民进行更不频繁的血糖监测，但我们发现许多 VA NH 居民接受了频繁的指尖血糖监测。鉴于不确定的获益和可能带来的大量患者负担和危害，我们的结果表明，对于许多低血糖风险较低的 NH 居民，减少指尖血糖监测可能是合理的。
