Appendix 5

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

• Carefully evaluate a 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 adverse drug events (ADEs) related to glucose-lowering medications (GLMs). Consider using 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 settings¹) 
  • Beers criteria² 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)³ 
  • Medication appropriateness index (The NO TEARS tool^4,5 can be useful to review medications and can be tailored to the individual practitioner's consultation style) 
  • Australian inappropriate medication use and prescribing tool⁶ 
  • AMH aged care companion (online) 
  • Australian type 2 diabetes management algorithm.⁷ 
• Consider the use of non-pharmacological alternatives where possible. 
• Simplify treatment regimens. 
• Avoid sliding scale insulin. 
• Conduct annual testing of estimated glomerular filtration rate (by a blood test) for screening and monitoring of chronic kidney disease for residents who are otherwise ‘healthy’ and whose care resembles standard care. 
• Seek multidisciplinary input (eg from credentialled 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. 
• Consider impacts on quality of life from side effects of common diabetes medicine (eg increased urination related to the use of sodium–glucose cotransporter 2 inhibitors for the person with urinary incontinence). 
• Ensure the resident, family members and aged care provider staff are educated regarding resident self-monitoring, documentation of blood glucose levels, symptoms of hypo- and hyperglycaemia and sick-day medication management strategies. For more information on sick-day management, refer to ‘Managing risks and other impacts of type 2 diabetes’. 

Source: Adapted from Stasinopoulos et al.⁸ 

The Royal Australian College of General Practitioners (RACGP) provides general guidance on aged care in the RACGP aged care clinical guide (Silver Book), an essential resource for general practitioners caring for older people in the community and residential aged care.