Reflecting on England’s first care home diabetes audit

The Diabetes UK publication Good Clinical Practice Guidelines for Care Home Residents with Diabetes published in 2010 gave comprehensive guidelines for the care of older people with diabetes (Diabetes UK, 2010). One of its recommendations was to call for a national care home diabetes audit. The Institute of Diabetes in Older People (IDOP), in collaboration with the Association of British Clinical Diabetologists (ABCD), undertook this audit throughout England, starting in September 2012 and continuing through 2013. A report was published last year (IDOP and ABCD, 2014).

Participants
In all, 2043 responses were obtained from the approximately 9000 care homes for elderly residents operating in England, a response rate of around 23%. The survey asked a number of questions about the management of diabetes in each home. Of those that responded, 1541 (75%) reported that they currently had residents with diabetes. There were 5087 residents with reported diabetes out of a total of 48978 (10.4%).

Main findings
The key findings from the audit are summarised in Box 1. As is concluded in the report, the findings highlight several areas of urgent concern relating to the safety of residents and their day-to-day health. There are areas where significant improvements could be made in terms of quality-of-life issues for residents and where linkage with NHS services could be greatly enhanced.

In the area of clinical care, important shortfalls occurred in the areas of hypoglycaemia and foot disease and these should be addressed urgently as these clinical conditions can result in medical emergencies. Disease monitoring was lacking in the areas of mood and cognitive assessment; these are important factors in ensuring the best quality of life for individuals and that will also have an impact on their care plans. Communication with primary care was found to be lacking.

Key recommendations are made in the report in the areas of:

• Clinical care.
• Monitoring of diabetes.
• Communication with primary care.
• Policies, management and training.

Implications for readers
This report highlights a number of problems in managing people with diabetes in care homes that readers need to be aware of. There is an urgent need to work in collaboration with care home staff to improve communication with primary care and to facilitate staff education in diabetes.