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Frailty and diabetes recommendations outlined in new JBDS guideline

By Editor
29th October 2019
Clinical guidance, Older people

A series of recommendations to assist in the clinical management of older adults with diabetes with a pre-existing or a new diagnosis of frailty in a hospital have been published.

Joint British Diabetes Societies for Inpatient Care (JBDS) has released Inpatient Care of the Frail Older Adult with Diabetes in a bid to improve standards of diabetes care of older frail inpatients in secondary care.

The document is aimed at every member of the inpatient team with direct care responsibility for frail older people admitted in hospitals and those health and social care professionals providing care for them before and after their hospital admission to prevent and minimise hospital stay. This will include hospital doctors, nurses, pharmacists, health care assistants, GPs, social care workers, carers, secretaries, ward clerks and other supporting staff.

Overall, it contains 113 recommendations to guide effective clinical decision-making over the eight key areas, including:

  • General inpatient management principles
  • Preventative care
  • Functional assessment and detection of frailty
  • Managing therapy choices for the frail older inpatient with diabetes
  • Managing associated comorbidities and concerns:
    • Cognition, delirium and dementia
    • Hypertension and Lipids
    • Falls
    • Inpatient hypoglycaemia – risk reduction
    • Principles
    • Chronic kidney disease
    • Acute stroke illness
  • Pre-operative Assessment and Care
  • Discharge planning and principles of follow-up
  • End of life care

The document predominantly discusses recommendations relating to those with type 2 diabetes, but also does cover type 1 diabetes. The document starts with a review of the guiding principles of the guideline followed by a theoretical brief review of the concept of frailty including definitions and then a discussion on frailty detection using various assessment tools that can be employed in routine clinical practice.

The lead authors were Coordinator and Co-Chair, Professor Alan Sinclair, Co-Chair Dr Umesh Dashora and fellow Co-Chair Dr Stella George.

Summarising the document, the authors said: “This JBDS Inpatient Guideline is unique as it has been developed to provide the clinician with recommendations that assist in the clinical management of older adults with diabetes with a pre-existing or a new diagnosis of frailty within a hospital inpatient setting. Such patients may already have various stages of ill-health associated with other medical comorbidities and provides the urgency to individualise management in all cases in order to achieve optimal outcomes.

“This Inpatient Guideline has tried to address these shortfalls in frailty care within hospitals by creating a comprehensive set of practical recommendations that are as evidence-based as possible bearing in mind the relative lack of published data of clinical trials in this area. We hope that all clinicians engaged in this emerging arena of clinical care will work collaboratively to develop an inpatient frailty pathway of care that serves to enhance clinical outcomes and overall health status for this vulnerable population of older people with diabetes.”

To access the guideline, click here.

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