Sinclair AJ, Gadsby R, Abdelhafiz AH, Kennedy M (2018) Failing to meet the needs of generations of care home residents with diabetes: a review of the literature and a call for action. Diabet Med 6 Jun [Epub ahead of print]
- These authors reviewed the literature on diabetes care in residential and nursing care homes, with a view to identifying where improvements can be made.
- Up to a third of care home residents have diabetes and there are high rates of comorbidities. High numbers are on insulin and have excessively low glycaemic targets, leading to hypoglycaemia. Residents with diabetes tend to enter a downward spiral of functional decline, sarcopenia, frailty and disability, which contribute to increased mortality at 12 months.
- Both residents and care staff tend to have little knowledge of diabetes or access to specialist care. Interventions that have been shown to improve care include an emphasis on avoiding hypoglycaemia rather achieving tight control, providing diabetes education to care home staff and providing teleconsultations with specialist healthcare teams.
- Suggested priority areas for improvements include having embedded policies of diabetes care; investment in the training of care home support staff; highlighting the importance of medication review and use of tools such as STOPP (Screening Tool of Older Person’s Prescriptions); minimising hypoglycaemia risk and applying appropriate glycaemic targets; and highlighting the importance of preventing physical and cognitive decline.
- The authors end with a call to action, calling health professionals and international bodies to give a greater prominence to older people with diabetes in care homes, and to undertake more research and audit in this vulnerable population.
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024