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In 2012, the American Diabetes Association (ADA) first published a position statement advocating a “patient-centered approach” for treatment of type 2 diabetes (NEJM JW Gen Med Aug 15 2012 and Diabetes Care 2012; 35:1364). Among other things, the statement recognized that stringent glycemic control was not appropriate for patients with limited life expectancies, extensive comorbidities, and high risk for hypoglycemia. These characteristics apply to many people in long-term care (LTC) and skilled nursing facilities, and now the ADA has issued a position statement on managing diabetes in such facilities.
Key points include:
Intensive glycemic control is of limited benefit in this population. Avoiding hypoglycemia is paramount; patients in LTC f…