Introduction: Diabetes is an increasing problem among old people as well as being a contributing factor in their need for institutional care. Comorbidity and use of medication is often greater among people with than without diabetes. The aim of this study was to investigate the prevalence of diabetes in Icelandic nursing homes over the period 2003-2012. Additionally we compared health, functioning, medication use and medical diagnoses of residents with diabetes to those without diabetes, living in nursing homes in 2012.

Material: Retrospective study of 16.169 Minimum Data Set 2.0 assessments, further analysis conducted for data from the year 2012 (n=2337).

Results: Mean age from 82.3 (SD 9.1) to 85.0 years (SD 8.4) and women were 65.5% to 68.0%. Number of residents with diabetes increased from 10.3% in the year 2003 to 14.2% in 2012 (p≤0,001). Mean age of residents with diabetes in the year 2012 was 82.7 compared to 85 years for others. Residents with diabetes had more skin problems, used more medication, their cognitive performance was better and their involvement in activities greater. They were more likely to have hypertension, arteriosclerotic heart disease, stroke, renal failure, manic depressive disorder, diabetic retinopathy or amputation. They were however, less likely to have an anxiety disorder, Alzheimer's disease or osteoporosis.

Conclusion: Residents with diabetes are younger than other residents and their cognitive performance is better, their care and treatment may however be complicated and needs to be adapted to each individual. Diabetes is an increasing problem in nursing homes and therefore an area where more knowledge among staff is needed.

Prevalence of diabetes and health status of Icelandic nursing home residents 2003-2012

Table I. Number of assessments each year and the characteristics
of the sample.

Year	n	%	Mean age (SD)	Women n (%)
2003	447	2,8	82,3 (9,1)	293 (65,5)
2004	1001	6,2	82,8 (8,5)	677 (67,6)
2005	1383	8,6	83,4 (8,2)	922 (66,7)
2006	1721	10,6	84,4 (7,9)	1149 (66,8)
2007	1922	11,9	84,4 (7,9)	1268 (66,0)
2008	1885	11,7	84,7 (8,2)	1247 (66,2)
2009	1867	11,5	84,9 (8,2)	1223 (65,5)
2010	1754	10,8	85,0 (8,4)	1192 (68,0)
2011	1852	11,5	84,5 (8,6)	1232 (66,5)
2012	2337	14,5	84,7 (8,2)	1531 (65,5)
Total	16169	100	84,2 (8,4)	11.294 (66,3)

Picture 1. Residents in Icelandic nursing homes (%) with diabetes over the years 2003-2012

Table II. Gender, age, health, functional profile and medication use of residents with and without diabetes living in Icelandic nursing homes in the year 2012.
	With diabetes	Without diabetes	P
N=2337 n (%)	332 (14,2)	2005 (85,8)
Females (%)	204 (61,4)	1327 (66,2)	0,105*
Mean age (sf)	82,7 (7,9)	85 (8,2)	<0,001**
Body mass index (SD)	27,1 (5,5)	24,7 (5,9)	<0,001**
Health and functional profile
CHESS scale*** (SD)	2,02 (1,42)	2,02 (1,38)	0,950**
Pain Scale mean (SD)	1,15 (0,97)	1,11 (0,96)	0,510**
Depression Rating Scale mean (SD)	2,71 (3,35)	2,89 (3,28)	0,370**
Cognitive Performance Scale mean (SD)	3,11 (1,80)	3,45 (1,79)	0,001**
ADL Long Scale mean (SD)	16,32 (8,75)	17,07 (8,34)	0,128**
Index of Social Engagement mean (SD)	2,86 (2,06)	2,51 (2,04)	0,004**
Infections
Urinary tract infectionn (%)	59 (17,8)	257 (12,8)	0,018*
Wound infectionn (%)	10 (3,0)	52 (2,6)	0,799*
Pneumonia n (%)	13 (3,9)	89 (4,4)	0,774*
Respiratory infection n (%)	15 (4,5)	72 (3,6)	0,503*
Skin conditions
Rashes n (%)	139 (41,6)	685 (34,2)	0,011*
Skin desensitized to pain n (%)	112 (33,7)	490 (24,4)	<0,001*
Ulcers stage 1-4 n (%)	70 (21,1)	345 (17,2)	0,102*
Ulcers stage 1 n (%)	36 (10,8)	198 (9,9)	0,656*
Ulcers stage 2 n (%)	40 (12,0)	180 (9,0)	0,094*
Ulcers stage 3 n (%)	7 (2,1)	13 (0,6)	0,019*
Ulcers stage 4 n (%)	2 (0,6)	6 (0,3)	0,712*
Medications
Number of medications mean (SD)	11,5 (4,23)	9,6 (4,15)	<0,001**
Hypnotics (NO5C) %(n)	48,5 (161)	48,2 (967)	0,976*
Antidepressants (NO6A) %(n)	53,6 (178)	55,1 (1105)	0,654*
Antianxietymedication (NO5B) %(n)	28,6 (95)	31,5 (631)	0,328*
Antipsychotics (NO5A) %(n)	25,0 (83)	27,2 (546)	0,434*
Use of 9 or more medications n (%)	255 (76,8)	1150 (57,4)	<0,001*
*Chi square test; **T test; ***Changes in Health, End-stage disease and Signs and Symptoms Scale

 

Table III. Disease diagnoses of residents with and without diabetes living in Icelandic nursing homes in the year 2012.
	With diabetes         n (%)	Without diabetes n (%)	P*
Hypertension	230 (69,3)	1111 (55,4)	<0,001
Arthritis	165 (49,7)	1047 (52,2)	0,428
Depression	142 (42,8)	919 (45,8)	0,327
Arteriosclerotic heart disease	124 (37,3)	574 (28,6)	0,002
Dementia other than Alzheimer's	118 (35,5)	714 (35,6)	1
Anxiety disorder	110 (33,1)	797 (39,8)	0,026
Cerebrovascular accident	89 (26,8)	392 (19,6)	0,003
Cardiac dysrhythmias	75 (22,6)	497 (24,8)	0,427
Congestive heart failure	73 (22,0)	367 (18,3)	0,13
Alzheimer's disease	64 (19,3)	582 (29,0)	<0,001
Osteoporosis	62 (18,7)	567 (28,3)	<0,001
Cataracts	53 (16,0)	323 (16,1)	1
Renal failure	48 (14,5)	153 (7,6)	<0,001
Other cardiovascular disease	47 (14,2)	295 (14,7)	0,856
Peripheral vascular disease	26 (7,8)	143 (7,1)	0,733
Manic depression	26 (7,8)	91 (4,5)	0,016
Diabetic retinopathy	25 (7,5)	2 (0,1)	<0,001
Transient ischemic attack (TIA)	16 (4,8)	119 (5,9)	0,496
Amputation	6 (1,8)	11 (0,5)	0,031
Hypotension	5 (1,5)	74 (3,7)	0,061

* Chi square test

Figure 2. Percentage of residents with diabetes each year and scores for the following scales: Changes in Health, End-stage disease and Signs and Symptoms Scale (0: individual is stable; 5: highly unstable); Pain Scale (0: no pain; 4: excruciating pain); Depression Rating Scale (0: no depression; 14: severe depression); Cognitive Performance Scale (0: cognitively intact; 6: severe cognitive impairment); ADL Long Scale (0: independent; 28: severe impairment); Index of Social Engagement (0: severe withdrawal from social engagement; 6: much initiative and participation in social activities).