Adherence to national diabetes guidelines through monitoring quality indicators—A comparison of three types of care for the elderly with special emphasis on HbA1c

• Poor monitoring of HbA1c for insulin and SU treatment endangers patient safety.
• Monitoring of diabetes in nursing homes is not according to guidelines.
• Long term coordination between primary and municipal health care is needed.
• Individual care plans for the elderly would facilitate deviations from guidelines.
• Foot examinations are provided a minority of residents of nursing homes.

AimTo compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.MethodsMedical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.ResultsMonitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p < 0.001). The HbA1c value of ≤6.9% (52 mmol/mol) was achieved for 48% of those in nursing homes with medication, 35% and 39%, for those living at home with or without home health care, respectively. Insulin was used to a greater extent in nursing homes. Metformin was frequently used, even at reduced e-GFR. Systolic BP ≤140 mmHg was achieved by 71% vs 80% and 85% of those living at home, those with home health care and residents of nursing homes in the respective groups.ConclusionsAdherence to guidelines was deficient particularly in nursing homes. Clearer guidelines and interventions aimed at the improvement of quality in diabetes care in elderly people and sustainable coordination between health care providers is needed.