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A Roadmap for Improving Diabetes Management in Long-Term Care Communities


Maximum Credits:


Print Publication Print Publication


Maximum Credits:
Print Publication Print Publication


Maximum Credits:

Overview: In early 2011, Med-IQ and Brookdale Senior Living embarked on a quality improvement initiative to understand the current state of care offered to long-term care community residents with diabetes and the educational desires and needs of staff providing this care. Two communities participated in retrospective chart reviews, care provider interviews, and live, certified CME workshops. This guide expands on the knowledge acquired from those efforts and offers a practical approach to improving diabetes care in long-term care communities, with a focus on the pivotal role of direct-care nursing staff.

CME Information:

Learning Objectives
Upon completion, participants should be able to:

  • Discuss appropriate protocols for assessing and establishing care plans for new residents
  • Create a process for the inclusion of individualized glycemic goals into comprehensive diabetes care plans
  • Develop and implement standards for monitoring blood glucose levels to achieve individual goals
  • Recognize the risk of diabetes-related complications and the need for ongoing assessment using standard operating procedures
  • Understand the importance of patient education and self-management in diabetes, even in the presence of functional and cognitive impairment

Patrick J. Boyle, MD
Emeritus Professor of Medicine
University of New Mexico Health Sciences Center

Belinda P. Childs, ARNP, MN, BC-ADM, CDE
Mid-America Diabetes Associates, PA
Wichita, KS

Katherine Kahn
Huntington, MA

Activity Planners
Kevin O'Neil, MD, CMD
Chief Medical Officer
Brookdale Senior Living, Inc.

Rita Vann, RN
Vice President, Clinical Services
Brookdale Senior Living, Inc.

Sara C. Miller, MS
Assistant Director, Educational Strategy and Content
Baltimore, MD

Rebecca L. Julian, MS
Managing Editor
Baltimore, MD

Target Audience
This activity is intended for geriatric medicine physicians, internal medicine physicians, nurses, certified nursing assistants, and pharmacists.

Series Overview/Statement of Need
Diabetes mellitus is an epidemic in the United States, affecting approximately 23.5 million adults. The prevalence of this disease increases with age, and currently 23.1% of all people older than 60 years have diabetes. An especially vulnerable subset of elderly patients includes those who are residents of long-term care (LTC) facilities, including assisted-living and skilled-care communities. LTC residents with diabetes experience a higher burden of comorbid disease, more pain, substantial polypharmacy, and an increased incidence of depression; they also require more nursing care. In addition, physicians and other healthcare professionals in LTC facilities often find that managing residents with diabetes is complicated by care transitions and cognitive limitations that interfere with patient-provider communication. Optimal care of these patients requires a team-based approach and healthcare professionals who are well versed in current guidelines and evidence.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Med-IQ designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Med-IQ is accredited by the California Board of Registered Nursing to provide continuing education to nurses.

Provider approved by the California Board of Registered Nursing, provider number CEP 14745, for 1.5 contact hours.

ACPE Med-IQ is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

1.5 contact hours (0.150 CEUs) of credit for pharmacists. ACPE #0476-0000-11-011-H04-P. This knowledge-based activity is designed for all pharmacists.

Statement of Participation
Nurse practitioners, physician assistants, and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Medium and Method of Participation
This complimentary CME activity consists of a 1.5-credit publication. To receive credit, each participant must read the introductory CME material, read the publication, and complete the post-test (answering at least 70% of the questions correctly), attestation, and evaluation.

Original Release Date: October 7, 2011
Expiration Date: October 6, 2012
Estimated Time to Complete This Activity: 1.5 hours

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Disclosure Statement
The content of this publication has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to provide unbiased content.

Patrick Boyle, MD
Consulting fees/advisory boards: Merck & Co., Inc.
Fees received for promotional/non-CME activities: Amylin Pharmaceuticals, Inc., Eli Lilly and Company, Takeda Pharmaceuticals North America

Belinda P. Childs, ARNP, MN, BC-ADM, CDE, has indicated no real or apparent conflicts of interest.

The writer (Katherine Kahn), activity planners (Rebecca L. Julian, Sara C. Miller, Kevin W. O'Neil, and Rita Vann), and other employees of Med-IQ have no financial relationships to disclose.

Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of CME. As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.

The information provided through this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

ADA Statement
Med-IQ fully complies with the legal requirements of the ADA and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the Director of CME at 443 543 5200.

Hardware/Software Requirements
Operating System
Microsoft Windows® 2000, XP, Vista
Mac OS 10.1, 10.2, 10.3, 10.4

Microsoft Internet Explorer 5.5 or later
Firefox 1.5
Netscape 7 or later

PDF Viewer
Adobe Acrobat Reader® or Adobe Reader
Download the latest version at

Connection Type
High bandwidth (300k) is strongly recommended
Low bandwidth (100k) results in less than optimal quality
Dial-up/modem is not recommended

Acknowledgment of Commercial Support
This activity is supported by an educational grant from sanofi-aventis U.S.

© 2011 Med-IQ®. All rights reserved.

Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

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