Development and implementation of diabetes guidelines for elderly residents in long-term care facilities in Nova scotia.

Background: The Diabetes Care Program of Nova Scotia (DCPNS) works across various sectors of the health care system to improve the care provided to people with or at risk of developing DM. The lack of evidenced-based DM guidelines for the elderly population has resulted in both under and over treatment of the frail elderly residing in NS’s long-term care (LTC) facilities. Overtreatment may result in increased rates of hypoglycemia—a potentially serious and underestimated clinical problem that has significant morbidity and mortality. Hypoglycemia can lead to poor balance and risk of falls, can be more severe and prolonged, and may precipitate a cardiovascular event. Current clinical practice guidelines set standards of glycemic control that may not be applicable to the residents of LTC facilities.