Management of type 2 diabetes: A handbook for general practice

Appendices

Appendix 5. Medication-related care plan considerations for aged care residents with type 2 diabetes mellitus

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Last revised: 17 Sep 2020

  • Carefully evaluate resident’s comorbidities, overall health and resident/carer preferences.
  • Ensure a sensitive discussion and documentation of an individualised treatment plan, glycaemic targets and strategies for medication management.
  • Start low and go slow with doses when initiating and/or changing medications, using appropriate investigations.
  • Assess and minimise the risk of hypoglycaemia and other ADEs related to GLMs. Consider use of the following resources when assessing medication use:
    • GLM-related ADEs risk assessment tool (available from the McKellar guidelines for managing older people with diabetes in residential and other care settings)
    • Beers criteria for potentially inappropriate medication use in older adults
    • STOPP: screening tool of older people’s potentially inappropriate prescriptions, and START: screening tool to alert doctors to right treatments
    • Medication appropriateness index
    • Australian inappropriate medication use and prescribing tool
    • Australian Medicines Handbook Aged care companion
    • Australian type 2 diabetes management algorithm
  • Consider use of non-pharmacological alternatives where possible.
  • Simplify treatment regimens.
  • Avoid sliding scale insulin.
  • Conduct annual testing of eGFR (by a blood test) for screening and monitoring of CKD, for residents who are otherwise ‘healthy’ and whose care resembles standard care.
  • Seek multidisciplinary input (eg from credentialed diabetes educators, aged care staff, pharmacists, allied health) where necessary.
  • Consider reviewing management when hypoglycaemia, falls, urinary tract or other infections, confusion or non-specific ‘incidents’ occur.
  • Ensure the resident, family members and aged care provider staff are educated regarding resident self-monitoring, documentation of BGLs, symptoms of hypoglycaemia and hyperglycaemia, and sick-day medication management strategies. A comprehensive approach to sick-day management is available from current Australian RACF guidelines.
ADEs, adverse drug events; BGLs, blood glucose levels; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; GLMs, glucose lowering medications; RACF, residential aged care facilities
 

Source: Adapted with permission from Stasinopoulos J, Bell J, Manski-Nankervis J, Hogan M, Jenkin P, Sluggett JK. Medication management of type 2 diabetes in residential aged care. Aust J Gen Pract 2018;47(10):675–81.