Integrated Diabetes Care in Canadian Long-Term Care: Insights from Residents and Caregivers

Background: In Ontario, Canada, nearly 40% of older adults living in long-term care (LTC) homes have diabetes. Many are managed to intensive glycemic targets counter to current clinical guidelines, which increases residents’ risks for medication-related harm, hypoglycemia, discomfort, and reduced quality of life. Deintensification (i.e., reducing or stopping diabetes medications, glucose testing, or dietary restrictions) is a recommended approach to reduce harm and improve quality of life in older adults. However, its implementation in LTC settings remains inconsistent. There is a pressing need to reframe diabetes care in LTC through integrated, person-centered approaches that prioritize safety, dignity, and lived experience.

 

Approach: This study is part of the DIAL (Optimizing Diabetes Management in Long-Term Care) project, which aims to co-design a resident and family centered-intervention for optimizing diabetes management in LTC. We conducted semi-structured interviews with 13 residents and 14 caregivers across diverse LTC settings in Ontario.

 

The interview guide was informed by the Theoretical Domains Framework (TDF) and deprescribing literature. Data were analyzed using a hybrid approach combining deductive coding based on TDF domains with inductive thematic analysis. The goal was to understand how residents and caregivers experience diabetes management and perceive deintensification

 

Results: Residents and caregivers both valued effective diabetes management, but their perspectives reflected distinct priorities shaped by their experiences. Residents, many of whom had previously self-managed their diabetes, emphasized the importance of clear communication and active involvement in care decisions (Knowledge). They expressed confidence in managing their condition, even within the constraints of institutional settings (Beliefs about Capabilities), and were acutely aware of the personal consequences of poor glycemic control, such as fatigue and discomfort (Beliefs about Consequences).

Caregivers identified systemic challenges that impacted their ability to support residents effectively, including staffing shortages, inconsistent communication, and limited access to diabetes-related information (Environmental Context and Resources).

 

They actively sought knowledge (Knowledge) and described varying levels of confidence in their caregiving roles (Beliefs about Capabilities), particularly when navigating complex care decisions.

Both residents and caregivers emphasized the need for improved staff training, transparent communication, and opportunities for collaborative decision-making. These insights reflect key principles of integrated care, including people as partners, workforce capability, and context-sensitive service design.

 

Perspectives on diabetes deintensification were nuanced. Some residents deferred to clinical teams, trusting their expertise, while others prioritized autonomy, particularly in decisions about diet and daily routines. Caregivers were generally more receptive to deintensification when presented as a respectful, shared process that aligned with the resident’s values and preferences.

 

Implications: These findings will inform the co-design of an integrated intervention that reflects the lived experiences and priorities of both residents and caregivers in long-term care. We will collaboratively develop tools and strategies to support safer diabetes deintensification, improve communication, and enhance autonomy. For international delegates, this study offers transferable lessons on embedding co-design into integrated care planning, ensuring that interventions are not only evidence-based but also person-centered, scalable, and responsive to aging populations.