Diabetes Mellitus, Glycemic Control, and Pneumonia in Long-Term Care Facilities: A 2-Year, Prospective Cohort Study

Objective: To determine the relationships among diabetes mellitus (DM), glycemic control, and long-term care facility (LTCF) acquired pneumonia. Design: Prospective cohort study. Setting: Ten private LTCFs in Taiwan. Participants: Participants were 233 LTCF residents. Measurements: Barthel index (BI), Charlson comorbidity index (CO), hemoglobin A1c, episodes of LTCF-acquired pneumonia. Intervention: None. Results: A total of 233 residents (76.9 +/- 10.6 years, 54.9% males, 27.9% diabetic) from 10 private LTCFs participated. There were 173 LTCF-acquired pneumonia episodes. The incidence of LTCF-acquired pneumonia between patients with and without diabetes, or between diabetic subjects with different status of glycemic control was similar. Adjusted for baseline BI, CCI, feeding tube placement, and baseline serum albumin, DM was not a significant risk factor for LTCF-acquired pneumonia. Poorer glycemic control (HbA1c >7%) was not a significant risk factor for LTCF-acquired pneumonia in diabetic subjects. Conclusions: Tighter glycemic control did not protect diabetic LTCF residents from pneumonia. A prospective randomized controlled trial is needed to determine the optimal goal of glycemic control for LTCF residents. (1 Am Med Dir Assoc 2011; 12: 33-37)