Calls are made to make frailty detection part of routine diabetes care
Frailty detection and management must become part of routine diabetes care in older people, according to a newly published commentary.
The article, published in Diabetic Medicine journal, was written to support the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) guideline, Inpatient Care of the Frail Older Adult with Diabetes.
The JBDS-IP guideline delivers three important key messages to those looking after the frail older inpatient with diabetes.
Firstly, while managing acute illness remains the first priority of older inpatients with diabetes, there is a necessity to provide a focussed assessment of functional status and detection of frailty to guide further management.
Secondly, frailty can be screened for using rapid and easy-to-learn methods that have been well validated in multiple populations of older people and finally, once frailty is detected, other outcome measures, such as assessing risk of hypoglycaemia, falls rate and quality of life need to be routinely included in the diabetes care plan along with glycaemic targets.
Professor Alan Sinclair, founder of the Foundation for Diabetes Research in Older People (fDROP), said: “Frailty is an important predictor of clinical outcomes and there is increasing recognition that early detection of frailty can help slow functional decline. Despite this, screening for frailty remains poor in most health care settings. This may partly be due to the fact that there is no agreed operational definition of frailty.”
In the article, Professor Sinclair praised the work that has been carried out by the National Diabetes Audit (NaDia) and the recent Getting it Right First Time initiative (GIRFT), but said he hoped both of those initiatives and similar projects elsewhere would “consider proactively to introduce frailty measures”.
Referring to COVID-19 among older people, Professor Sinclair said: “As frailty is now recognised as a significant predictor of adverse outcomes in older adults admitted to the hospital, it is not surprising that the ongoing COVID-19 pandemic has further highlighted the magnitude of this association particularly in those with diabetes.
“We feel that further delay in introducing frailty considerations into diabetes care guidance, protocols and audits could lead to a state of continuing suboptimal clinical care and may even be seen as a lack of equity of care for older people within diabetes health care systems. Frailty detection and management must now become part of routine diabetes care.”
To read the article in full, click here.