Pharmacist Led Diabetes Disease State Management in Residential Care Facilities

  • Author / Creator
    Featherstone, Travis R
  • Seniors requiring advanced care and supports are often residing in residential care facilities (RCF). Although, up to 33% of the residents are living with known diabetes, administrators and clinicians are faced with two important questions: 1) what is the prevalence of undetected diabetes; and, 2) what are the best management practices for residents of seniors’ facilities with diabetes? Gaps in diabetes management have led to multiple international guidelines in the last 5 years, illustrating a growing recognition of the importance of these issues. Pharmacists are uniquely positioned in a growing multidisciplinary environment to assist or oversee diabetes disease state management in this population. The first study of this thesis, tests the effectiveness of two validated diabetes risk surveys to identify residents of RCFs living with undetected diabetes. The second study is a systematic review that examines current diabetes management strategies in RCFs. The first study, a cross sectional survey compared the CANRISK and FINDRISC with A1c. 290 residents participated; mean age 84.3 (SD 7.3) years, 82 (28%) men, mean A1c 5.7% (SD 0.4). Mean CANRISK score was 29.4 (SD 8.0) and of the 254 (88%) considered moderate or high risk, 10 (4%) had an A1c≥6.5 and 49 (19%) had an A1c≥6.0%. Mean FINDRISC score was 10.8 (SD 4.2) and of the 58 (20%) considered high or very high risk, 4 (7%) had an A1c≥6.5% and 15 (26%) had an A1c≥6.0%. The area under the receiver operating characteristic curve was 0.57 (95% CI 0.42-0.72) for the CANRISK survey identifying participants with an A1c≥6.5% and 0.59 (95% CI 0.51-0.67) for identifying A1c≥6.0%. Similar characteristics were observed for the FINDRISC survey. Although we found a statistically significant correlation between these measures, the risk scores were unable to effectively discriminate between seniors with elevated and normal blood glucose. In the systematic review, a total of 1639 articles were screened and 3 studies with a combined sample of 685 residents met the inclusion criteria. Two were uncontrolled before and after studies and one was a non-randomized controlled trial. Glycemic control was the most common measure of program efficacy, along with rates of hypoglycemia. The systematic review identified an important evidence gap to help guide diabetes management in this population as well as areas for pharmacist involvement in the process of care including: development of policy and procedures for diabetes, education to the staff and sliding scale insulin reductions. In conclusion, observations from these studies suggest pharmacists should not recommend implementation of diabetes risk tools in admission or resident screening and should instead use their expanded scope of practice to order an A1c as a screening test. Furthermore, by implementing the process of care identified, pharmacists can demonstrate a quick impact to diabetes management in RCF settings.

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  • Graduation date
  • Type of Item
  • Degree
    Master of Science
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    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.