Quality of care to institutionalized patients with diabetes in Italy: a national survey

Key summary points Aim To evaluate the epidemiology of diabetes and quality of care to institutionalized older patients with diabetes in Italy. Findings Diabetes is a widespread condition within nursing homes in Italy (Prevalence 19.3%). Great heterogeneity in assisting nursing home residents with diabetes. Lack of communication and information exchange between doctors and nursing staff Discrepancies between what is recommended in guidelines and the real-world practice Message The institution of local diagnostic-therapeutic-pathways, shared by all caregivers, should be encouraged and properly funded to overcome communication problems between doctors and nurses and eventually improve the quality of care in institutionalized patients with diabetes. Purpose To evaluate the epidemiology of diabetes and quality of care of institutionalized patients with diabetes in Italian nursing homes. More specifically, to evaluate the adherence to the national/international guidelines for the management of older people with diabetes. Methods Data related to the epidemiology of diabetes and the quality of care were collected from questionnaires sent to 41 nursing homes. Data were extracted from papers, electronic medical records and validated operating protocols regulating the management of patients with diabetes in various homes. Completed questionnaires were returned in electronic format and centrally processed. Results Out of 4692 residents, 906 (19.3%) had diabetes. Among these residents, excluding patients undergoing diet treatment, more than half were on insulin treatment (alone or in combination with oral antidiabetic agents). The critical findings can be summarized as follows: a lack of shared diagnostic-therapeutic protocols, specifically related to evaluation of frailty; the preparation of nutritional and physical activity plans; the clarification of the objectives of the treatment; the timing of insulin administration (frequent use of sliding scale); the frequency and timing of capillary blood glucose; metabolic control methods; hypoglycemia and hyperglycemia treatment; and the scant use of new drugs that do not cause hypoglycemia. Conclusion Our data revealed substantial heterogeneity in the treatment of nursing home residents with diabetes in Italy with many discrepancies between what is recommended in the guidelines and real-world practice. The implementation of local diagnostic-therapeutic protocols shared by all caregivers should be encouraged and properly fu