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Guidelines for Diabetes Care in Long Term Care Facilities

PDF Version of BQA 00-048 (PDF, 11 KB)

Date: July 3, 2000 DSL-BQA-00-048

To: Nursing Homes NH 26 Attention:  Directors of Nursing

From: La Vern Woodford, Chief, Resident Care Review Section
Pat Zapp, Director, Wisconsin Diabetes Control Program

via: Susan Schroeder, Director, Bureau of Quality Assurance

Diabetes is a common, costly, but controllable disease in Wisconsin. It is estimated that approximately 330,000 people have diabetes in Wisconsin, 158,360 of whom are over the age of 65. Complications of diabetes include blindness, nerve damage and kidney disease.

In 1994, the Wisconsin Department of Health and Family Services established the Wisconsin Diabetes Control Program. The goal of the program is to improve care for individuals with diabetes in Wisconsin. The Diabetes Control Program established the Wisconsin Diabetes Advisory Group, a group now made up of more than 50 statewide organizations working to improve care for individuals with diabetes. (A list of the Advisory Group organizations is attached.) The Advisory Group worked together to develop the Wisconsin Essential Diabetes Mellitus Care Guidelines. These guidelines have been widely distributed in Wisconsin. A copy of the Guidelines can be downloaded from the website: (address updated)

We wanted to provide guidelines for the care and management of residents with diabetes in long term care settings. We found the enclosed guidelines to be practical and sensitive. The guidelines were developed by Minneapolis/St. Paul Diabetes Educators, Minnesota Long-term Care Organizations, Gerontology Practitioners and the Minnesota Diabetes Control Program. These guidelines were updated at the end of 1999 and incorporate information from recent research and standards of care.

The goals of the guidelines include:

  • To prevent crises or suffering related to inadequate control of diabetes mellitus in the long term care setting.

  • To prevent and treat complications of diabetes mellitus in order to preserve function and maintain an optimal quality of life.

There is a great deal of patient variability in the long-term care setting. Facilities now care for elderly residents, as well as younger residents, admitted for short-term sub-acute care. Many residents are also quite frail. They often suffer from multiple chronic illnesses that worsen with age. This often makes treatment decisions very complicated and requires careful balancing of choices.

When specific treatments are suggested, it is crucial to determine if aggressive treatment is appropriate. Specific treatments may not be indicated if the resident is terminally ill, has an end-stage condition, or when the treatment would not change the resident’s outcome. The wishes of the resident and his/her family should play a major role in the decision-making process.

We would like to know your thoughts about the guidelines. Please complete the enclosed form [not available on the Internet] and return it in the self-addressed envelope. If the Diabetes Control Program staff can be of assistance to you, please do not hesitate to call Pat Zapp, Director, Diabetes Control Program at (608) 261-6871. You can also e-mail Pat Zapp at

Together, we can make a difference in the lives of the individuals in Wisconsin with diabetes.

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