Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes

Introduction: The increasing prevalence of diabetes worldwide entails an expected rise in the number of older individuals with diabetes needing nursing home placement. Internationally, a consistent lack of adherence to clinical guidelines has been identified in the care of older people. In this study, we therefore investigated whether diabetes management in a sample of nursing homes in Norway and Iceland was in accordance with clinical guideline recommendations. Methods: We used a descriptive cross-sectional study design to assess diabetes management in 12 nursing homes: eight in Norway and four in Iceland. Results: We identified 162 residents with diabetes. The diagnosis of diabetes was available for 100% of the residents in the nursing homes in Iceland and respectively for 81 and 51% of the residents in southwestern and northern Norway. Totally, 3% of the residents with diabetes had a treatment goal for blood glucose regulation (HbA1c) documented in their medical record, 48% had agreed individualized routines for blood glucose measurements and 37% had a HbA1c value measured within the past 6 months available in their medical record. Conclusion: This study has shown a significant discrepancy between diabetes guideline recommendations and clinical diabetes practice related to documenting the diagnosis and type of diabetes, the establishment of individualized treatment goals for HbA1c and the establishment of routines for blood glucose and HbA1c measurements in nursing homes in Norway and Iceland. The results indicate a potential for improvement and a need for more nurses with advanced competence within diabetes in nursing homes.