Episode 11: Bridging the Diabetes Care Divide

Andie Cartwright

Hey everyone, I'm Andie Cartwright, and welcome back to Better Living Through Data. I'm joined by Anthony Pero. Today, we’re talking about diabetes care in long-term care—because the numbers, honestly, kind of shocked me when I first saw them.

Anthony Pero

Yeah, Andie, the prevalence is high. For U.S. adults over 75, type 2 diabetes affects about 17.5% of women and 21.1% of men. When you look at residents in skilled nursing facilities, this is a huge piece of the population—they're not outliers, they’re almost the norm.

Andie Cartwright

Exactly, and what’s surprising is, even with that, 26% of long-term care residents diagnosed with diabetes received no guideline-directed medication at all. That's over a quarter, just not receiving any treatment that’s in line with what the American Diabetes Association recommends. I keep thinking about my own experience with this—my grandmother was in long-term care. There was always this sort of, I don't know, confusion? I remember these care meetings where her medication list would be read off, and half the time, I wasn’t even sure if she was actually receiving her diabetes meds, or if it was just a placeholder on the chart because her blood sugar was “stable that week.”

Anthony Pero

And sadly, that's not rare. The data from PointClickCare’s EHR analysis showed that, out of nearly half a million long-term care residents living with diabetes, only about 74% had any diabetes medication prescribed at all. Even though there’s clear evidence you get better outcomes by treating diabetes—less hypoglycemia, fewer complications—there are still those big gaps for so many residents.

Andie Cartwright

Right, and, like we’ve talked about on past episodes, these treatment gaps—it’s not always about “forgetting” to prescribe, right? Sometimes it’s complicated regimens, polypharmacy, or providers just trying to balance side effects and comorbidities. But, twenty-six percent untreated is way too high. Even from a risk perspective, that’s...that’s not where we should be landing.

Anthony Pero

Agreed. And the question becomes—where are these gaps coming from? Why are we, even in 2025, seeing so many residents just not getting on a guideline-recommended regimen?

Anthony Pero

One of the clearest trends we found was disparity by both race and geography. Specifically, Black or African American residents and those living in the South or Midwest had about 15% lower odds of receiving guideline-directed diabetes medications. And that isn’t a small difference, either—it’s systemic.

Andie Cartwright

When I first saw that stat, I had to double-check. Like, “Am I reading this right?” But yeah, fifteen percent lower odds, just based on where you live or your background. We've talked a lot about how regional practices and biases sneak into care—I mean, look at our third episode about medication access—but this is one of the starkest examples. And it gets even more interesting, or maybe frustrating, when you look at newer medications like GLP-1 receptor agonists. Despite being really prominent in the latest ADA guidelines, only 8% of residents were actually using them. That’s better than the 0.5% in previous studies, but when you think about the benefits of these drugs? It feels like such slow progress.

Anthony Pero

Totally—there’s this real inertia on the ground. I was just thinking about a facility I visited in the Midwest. They had the clinical guideline posters right there in their break rooms, but when we looked at what folks were actually getting, it was almost all older medications. Very little use of GLP-1 agonists or SGLT2 inhibitors. When we went a bit deeper, local providers said things like, “Well, insurance doesn’t always cover the new stuff,” but that’s a common misconception It’s not necessarily bad intent, but the result is the gap you see in the numbers.

Andie Cartwright

And I think the data really pulls the curtain back, here. Treatment rates were roughly 10% lower for long-term care residents compared to similar folks in the community—so it’s not just that people in nursing homes are more complex. There’s something else...systemic. And this isn’t unique to diabetes. Building on what we found in last episode’s discussion about medication inequity, it’s the same playbook: the newest, most effective therapies are slower to trickle down to the most vulnerable.

Anthony Pero

Yeah, and it’s, I’m gonna say it, kind of infuriating. Because these medication classes—especially the GLP-1s—have the potential to really change outcomes, especially for older folks with comorbidities. But if only a sliver gets access, where’sthe benefit?

Andie Cartwright

Exactly. And the disparities aren’t just a data point, they translate into years of poorer health for real people. The positive, if you can call it that, is that mapping out these patterns makes them a target for future change.

Andie Cartwright

It’s clear these disparities don’t just happen. There are reasons behind them. In the research, prescriber-level barriers were actually called out, like racial bias or regionally-influenced education. That’s hard to talk about for a lot of people, but the numbers don’t lie.

Anthony Pero

And even if we look at which meds are being used: insulin led, prescribed to about 48% of residents with diabetes, followed by biguanides—which is basically metformin—at just over 30%. Then SGLT2 inhibitors at 16%, sulfonylureas at 9%, GLP-1s at 8%, DPP-4 inhibitors at right around 8%. It’s great to have options, but you wanna see more alignment with what really works, especially in frail older adults.

Andie Cartwright

Absolutely. The issue is, even with this basket of meds and all the data showing which ones improve outcomes, prescribers are still slow to change. Maybe it’s training, maybe it’s just habit. But that’s why the study points to the value of real-world EHR data. By aggregating millions of records from PointClickCare and analysis done in partnership with McMaster University, we can actually see in close to real time where the gaps are, and update guidelines that matter for the people actually living this every day.

Anthony Pero

Yeah, and when you get granular like this, systems can design interventions that address those gaps—whether it’s tackling implicit bias, offering prescriber training, or adjusting for regional quirks. Real-world evidence isn’t just confirming what we already thought or hoped for; it’s showing exactly where care breaks down, so you know where to act.

Andie Cartwright

And that’s kind of where the hope is, right? We’re not just describing a problem, we’re building a path toward solutions—using the same data to make future guidelines smarter and more targeted. That’s not just statistics; it’s lives changed on the other side. Anthony, always a pleasure diving into this with you.

Anthony Pero

Thanks, Andie, and thank you all for joining us again. There’s so much more to explore when it comes to data and better outcomes for vulnerable populations. We’ll be back with another episode soon. Take care, everyone.

Andie Cartwright

See you next time on Better Living Through Data!