The prevalence and persistence of sliding scale insulin use among newly admitted elderly nursing home residents with diabetes mellitus.

OBJECTIVE To evaluate the initiation and persistence of sliding scale insulin (SSI) therapy in elderly nursing home (NH) residents. DESIGN AND PARTICIPANTS A longitudinal study of NH residents (N = 9804) with diabetes aged 65 years and older who were admitted between 2002 and 2003 and resided for 1 month or longer in long-term care facilities associated with a for-profit nursing home chain. RESULTS Rates of SSI use were high among patients who were started on insulin during their stay in nursing homes (54%), and 22% of the total number of orders for insulin were for SSI. After insulin initiation, 83% of residents who were started on SSI remained on it by the end of the study. Of those who had not started on SSI, 33% were later switched to SSI. DISCUSSION This study demonstrated that SSI regimens were highly prevalent and, once initiated, tended to be continued in the treatment of elderly patients with diabetes newly admitted to nursing homes. Multiple factors were found to be significantly associated with initiation and persistence of SSI. CONCLUSION The high prevalence and persistent use of SSI is inconsistent with the American Medical Directors Association guideline as well as current recommendations. Additional studies are needed to evaluate outcomes associated with prolonged SSI use in long-term care facilities.