Undiagnosed diabetes mellitus and metabolic control assessed by HbA(1c) among residents of nursing homes

Aims/hypothesis. Diabetes prevalence and diabetes care in residents of nurs ing homes is a neglected area of research although the growing number of el derly people with diabetes represents a growing challenge for health care i n most countries. In this study, we used HbA(1c) measurement to estimate th e percentage of residents with undiagnosed diabetes and the quality. of met abolic control of subjects with known diabetes in nursing homes. - Methods: All 41 nursing homes in the county of Heinsberg in Northrhine-Westfalia we re asked to complete a structured questionnaire on the prevalence of known diabetes among all residents. In addition, all residents were offered measu rement of glycated haemoglobin A1c (HbA(1c)) from a capillary blood sample. Undiagnosed diabetes was defined by a HbA(1c) level greater than 6.0%. - R esults. 39 nursing homes participated in the study comprising 99.6% of all residents. Among the 1936 residents 507. (26.2%) were known to suffer from diabetes. Among the latter 37.0% were under insulin treatment. Blood sample s for the determination of HbA(1c) were obtained from 979 subjects from 20 nursing homes. Among those 60 years old or above (n=843) the mean level of HbA(1c), in those with known diabetes was 7.3 +/- 1.5% and in those without 6.1 +/-0.9%. Only 16.7% of the subjects with known diabetes had a HbA(1c) greater than 8.5% indicating poor metabolic control. Among the residents pr eviously not known to have diabetes 47.2% had a HbA(1c), equal to or greate r than 6.1%, but among those only 8.5% had a HbA(1c) greater than 7.0%. Con clusions/interpretation: Although the prevalence of undiagnosed diabetes me llitus defined by HbA(1c) above the normal range in elderly nursing home re sidents is high, only few may require treatment. The quality of metabolic c ontrol among those with known diabetes mellitus is better than expected.