Clinical Expert Consensus on Standard Care of Blood Glucose for Residents in Senior Care Facility in China (2021 Edition)
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GUIDELINES AND CONSENSUS
Clinical expert consensus on standard care of blood glucose for residents in senior care facility in China (2021 edition)
Shuang Wang¹ | Junkun Zhan² | Mei Cheng³ | Qi Pan⁴ | Zhen Liang⁵ | Xiaohong Liu⁶ | Wen Peng⁷ | Xiaopei Cao⁸ | Yingquan Luo⁹ | Dongmei Kang¹⁰ | Youshuo Liu² | Endocrine Metabolic Diseases Group of the Chinese Geriatrics Society, Chinese Medical Association
¹Center of Gerontology, National Clinical Research Center for Geriatric Disorders, West China Hospital, Sichuan University, Chengdu, China
²Department of Geriatrics and Geriatric Endocrinology, The Second Xiangya Hospital, and the Institute of Aging and Geriatrics, Central South University, National Clinical Research Center for Metabolic Diseases (The Second Xiangya Hospital), Changsha, China
³Department of Geriatrics, Department of Geriatric Endocrinology, Qilu Hospital, Shandong University, Jinan, China
⁴Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Beijing, China
⁵Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China
⁶Department of Geriatrics, Peking Union Medical College Hospital, Beijing, China
⁷Department of General Medicine, Union Hospital Affiliated to the Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
⁸Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
⁹Department of General Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
¹⁰Department of Geriatrics, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
ABSTRACT
With demographic changes, more elderly people choose to live in senior care facilities. Residents commonly suffer from geriatric syndromes (declined daily living activities, cognitive dysfunction, frailty, comorbidities, polypharmacy), increasing risks of hypoglycemia and falls. Layered, individualized management is essential. However, staff knowledge and skills in diabetes care vary widely, requiring urgent standardization. Based on literature review and panel discussion, 30 recommendations are proposed for standardized blood glucose management, covering comprehensive geriatric assessment, stratified grouping, exercise, nutrition, glucose monitoring, severe hyperglycemia, macrovascular/microvascular complications, hypoglycemic agents, falls/choking, non-diabetic screening, hypoglycemia prevention/treatment, emergency/disaster management, and telemedicine/smart healthcare applications. This consensus aims to standardize care and improve quality of life for elderly residents.
Keywords: blood glucose; elderly; senior care facility
1 | INTRODUCTION
Senior care facilities provide full-time centralized accommodation and nursing for the elderly (≥10 beds). Common geriatric syndromes include:
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Declined activity of daily living (80.7%)
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Cognitive dysfunction (80.5%)
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Polypharmacy (44.7%)
These issues reduce quality of life and increase risks of hypoglycemia and falls. Under China’s “medical-nursing integration” policy, facilities are improving health management via hospital partnerships or in-house medical departments.
This consensus was developed by experts in geriatrics, endocrinology, and general practice, following principles of practicality, simplicity, and advancement, integrating global guidelines and local experience. It guides doctors, nurses, and caregivers in standardized blood glucose management.
2 | GLUCOSE CONTROL IN SENIOR CARE FACILITY
Resident health status varies widely (active → disabled → cognitively impaired). Staff competence in diabetes management is inconsistent. Individualized, stratified programs are necessary.
Recommendation 1
Conduct comprehensive geriatric assessment (CGA) for residents ≥70 years (refer to Chinese Expert Consensus on CGA). For those with malignant tumors, perform survival prediction using Karnofsky Performance Status (KPS) and Palliative Prognostic Score (PPS).
Recommendation 2
Facility physicians must master assessment tools for:
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Cognitive function
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Activities of daily living (ADL)
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Frailty status
Recommendation 3
Stratify residents into 3 groups for targeted management:
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Active elderly: aged but not frail
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Semi-disabled elderly: aged and frail with partial function
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Disabled elderly: severe functional impairment
3 | MANAGEMENT OF ELDERLY DIABETES PATIENTS
3.1 | Glucose Control Targets
Targets are individualized based on comorbidities, functional status, and life expectancy.
Recommendation 4
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Active elderly / life expectancy ≥10 years: targets same as adults
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Semi-disabled / life expectancy ≤5 years: HbA1c <8.0%
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Disabled / life expectancy 6–12 months: avoid acute hyperglycemia complications
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Terminal / no oral/enteral feeding: discontinue hypoglycemic therapy if appropriate
Recommendation 5
Set regular reassessment intervals for each group to detect status changes and adjust strategies.
3.2 | Non-Pharmacological Management
3.2.1 | Exercise
Exercise is a cornerstone of diabetes care: improves insulin sensitivity, lipid metabolism, cardiopulmonary function, and immunity.
Recommendation 6
Prescribe exercise intensity per classification (Table 2):
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Moderate: 5–6 on Borg scale
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High: 7–8 on Borg scale
Recommendation 7
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Active elderly: moderate aerobic exercise + periodic strength/coordination training
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Semi-disabled: bedside strength, balance, and flexibility training
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Disabled: passive limb movements to prevent complications
Recommendation 8
Not all elderly diabetics can exercise; provide timely guidance. Avoid excessive duration/intensity.
Recommendation 9
Safe exercise range: 5.5–16.7 mmol/L (stable diabetes, especially obese/IGT).
Contraindications:
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Severe insulin deficiency (before supplementation)
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Unstable blood glucose
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Diabetic retinopathy with hemorrhage
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Severe diabetic nephropathy (renal failure)
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Uncontrolled severe hypertension/cardiovascular disease
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Acute infection, ketoacidosis, cor pulmonale, etc.
3.2.2 | Nutrition
Goals: maintain ideal blood glucose, prevent malnutrition, support quality of life.
Recommendation 10
Total energy: 25–30 kcal/kg/day; adjust for frailty/obesity.
Recommendation 11
Carbohydrates: 45–60% of calories; prioritize low-GI, high-fiber foods.
Recommendation 12
Protein: 1.0–1.2 g/kg/day; increase to 1.2–1.5 g/kg/day for malnourished/frail.
Recommendation 13
Fat: 20–30% of calories; limit saturated/trans fats; prioritize unsaturated fats.
Recommendation 14
Salt: <5 g/day; avoid processed foods.
Recommendation 15
Meal pattern: 3 main meals + 2–3 snacks; consistent timing/portion.
Recommendation 16
Weigh weekly; obese: 0.5–1.0 kg/week weight loss (max 2 kg/month) until ideal weight.
Recommendation 17
Dietary structure:
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Abundant vegetables (≥500 g/day)
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Moderate fruits (low-GI)
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Soybeans, nuts, eggs, dairy, fish, lean meat
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Healthy oils (olive, canola)
3.3 | Glucose Monitoring
Primary method: fingertip blood glucose testing.
Recommendation 18
Monitoring frequency (Table 5):
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Active: fasting + 2h postprandial 2–3×/week
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Semi-disabled: fasting + 2h postprandial 3–4×/week
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Disabled: fasting + bedtime 4–5×/week; adjust for instability
Recommendation 19
Record: glucose values, time, diet, exercise, medications, symptoms.
Recommendation 20
Review records monthly; adjust therapy as needed.
Recommendation 21
HbA1c every 3 months; every 6 months if stable.
3.4 | Severe Hyperglycemia
Definition: blood glucose ≥16.7 mmol/L; risk of ketoacidosis/HHS.
Recommendation 22
Identify triggers: infection, stress, non-adherence, steroid use.
Recommendation 23
Mild hyperglycemia (16.7–22.2 mmol/L):
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Recheck in 1–2 hours
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Encourage hydration
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Review diet/medication
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Notify physician if persistent
Recommendation 24
Severe hyperglycemia (>22.2 mmol/L) or with symptoms (polyuria, polydipsia, fatigue, confusion):
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Immediate medical evaluation
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Consider insulin therapy
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Rule out ketoacidosis/HHS
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Hospital transfer if unstable
3.5 | Diabetic Complications
Screen for macrovascular (cardio/cerebro/peripheral vascular) and microvascular (retinopathy, nephropathy, neuropathy) complications.
Recommendation 25
Annual screening:
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Blood pressure, lipids, ECG
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Foot exam (sensation, pulses, skin)
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Retinopathy (fundoscopy)
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Nephropathy (urine albumin/creatinine ratio, eGFR)
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Neuropathy (vibration/touch sensation)
Recommendation 26
Refer to specialists for abnormal findings.
Recommendation 27
Foot care: daily inspection, proper footwear, nail care, prevent trauma.
3.6 | Hypoglycemic Agents
Prioritize safety; minimize hypoglycemia risk.
Recommendation 28
Preferred agents:
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Metformin (if renal function allows)
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DPP-4 inhibitors
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SGLT2 inhibitors (CV/renal benefits)
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GLP-1 RAs (weight neutral/beneficial)
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Low-risk sulfonylureas (e.g., gliclazide MR)
Recommendation 29
Avoid:
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High-risk sulfonylureas (glibenclamide)
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Insulin secretagogues with high hypoglycemia risk
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Long-acting insulin (unless necessary)
Recommendation 30
Insulin use:
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Basal-bolus for uncontrolled patients
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Start low, titrate slow
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Educate on injection, monitoring, hypoglycemia management
4 | SCREENING FOR NON-DIABETIC RESIDENTS
Recommendation 31
Annual screening for all residents:
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Fasting glucose
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2h post-load glucose (if indicated)
Recommendation 32
Normal: FPG <6.1 mmol/L and 2h-PG <7.8 mmol/L
Recommendation 33
Prediabetes/diabetes:
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FPG ≥6.1 or 2h-PG ≥7.8 mmol/L
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Refer to endocrinologist for diagnosis/management
5 | HYPOGLYCEMIA
Definition
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Non-diabetic: <2.8 mmol/L
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Diabetic: <3.9 mmol/L
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Elderly threshold: treat at <5.0 mmol/L (pre-emptive)
Symptoms
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Classic: hunger, palpitations, sweating, tremor, pallor, dizziness
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Atypical (elderly): confusion, behavioral changes, falls, arrhythmia, syncope, coma
Recommendation 34
Prevent via education and early detection.
Recommendation 35
Treat immediately if <3.9 mmol/L; pre-emptive care at <5.0 mmol/L.
Recommendation 36
Treatment algorithm (Figure 7):
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Conscious: 15 g fast-acting carbs (juice, candy, glucose tabs)
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Recheck in 15 min; repeat if still <3.9 mmol/L
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Unconscious: glucagon injection or IV dextrose; emergency transfer
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Recurrent hypoglycemia: hospital evaluation for cause
6 | FALLS AND CHOKING
Recommendation 37
Fall prevention:
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Regular balance/gait assessment
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Safe environment (non-slip floors, grab bars, adequate lighting)
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Appropriate footwear
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Medication review (reduce CNS-active drugs)
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Exercise (balance, strength)
Recommendation 38
Choking prevention:
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Soft, easy-to-chew diet
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Small bites, slow eating
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Supervision during meals
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Heimlich training for staff
7 | EMERGENCY AND DISASTER MANAGEMENT
Recommendation 39
Develop emergency protocols per national regulations.
Recommendation 40
During public health emergencies/natural disasters:
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Ensure supply of glucose meters, strips, medications, glucagon
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Maintain communication with hospitals
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Provide emotional support
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Use telemedicine for consultation
Recommendation 41
Establish tele-education/consultation platforms with hospitals to enhance care quality.
8 | CONCLUSION
This consensus provides evidence-based, practical guidelines for blood glucose management in senior care facilities. Implementation will standardize care, reduce complications (especially hypoglycemia), and improve quality of life for elderly residents.