New measures to support ‘let down’ older people with diabetes and frailty
New measures have been unveiled to support older people with diabetes who are “let down” by the system.
Professor Alan Sinclair said older people with diabetes were “often overlooked and over medicated” and it was time to give them the “care and attention” they deserve.
He was speaking following the fourth meeting of the Older People’s Diabetes Network (OPDN) and ahead of the publication of his guidelines entitled ‘An International Position Statement on the Management of Frailty in Diabetes’, which has just been published.
The document formalises a frailty service model spanning primary, secondary and community care in a bid to prevent frailty and ensure the early management of the condition.
Professor Sinclair, who is the Network’s clinical lead, was among a series of high-profile speakers at the event staged on Wednesday, September 27, at Friends House, London, hosted by RIA Diabetes & Education, an organisation dedicated to excellence in diabetes education and care.
Professor Sinclair said: “Frailty has become recognised as a new complication of diabetes in ageing populations and needs to be a priority for action.
“This is because frailty leads to excess disability in diabetes leading to earlier institutionalisation, decreased quality of life, and premature death. Yet early prevention and management leads to longer, healthier lives.
“Quite simply older people with diabetes developing are being let down by the system, that’s why I have led the development of new international guidelines to illustrate and share a better way of caring for these people.
“It is part of a wider problem as generally older people with diabetes were often overlooked and over medicated, but we now need to give them the care and attention they deserve.”
The international guidelines provide a series of recommendations in key areas that will support clinicians in everyday clinical practice to manage more effectively the complex issues seen in ageing individuals with frailty.
It will also offer a platform for commissioners and policy makers to plan and coordinate care pathways in their local regions for those older people with diabetes who are developing frailty, have developed frailty, and those progressing to disability.
The aim of the Network is to bring together health and social care professionals who share the aim of ensuring older people with diabetes get the highest quality of care.
Fellow speaker Professor Roger Gadsby, Honorary Associate Clinical Professor, Warwick Medical School, University of Warwick, gave a talk titled ‘My Reflections on Primary Care for Older People with Diabetes’.
He concluded: “Most residents in nursing homes are in the last year of life and need to be managed accordingly.
“We need recognition that those living independently or being supported at home and who have issues of dependency, frailty, dementia should be treated differently and kept out of hospital. There is plenty of work for all to do in increasing prevalence and increasing dependency.”
Dr Ahmed Abdelhafiz, Consultant Geriatrician, Rotherham General Hospital, said overtreatment of older people with diabetes was common and de-intensification of hypoglycaemic medications was feasible.
During his talk ‘De-escalation of Treatment in Older Adults with Diabetes-What Does This Mean?’, he also called for “pragmatic guidelines” on de-intensification.
King’s College London’s Professor Angus Forbes, who is the Foundation of European Nurses in Diabetes (FEND) Chair in Clinical Diabetes Nursing, said glycaemic variability may be an “important factor” in understanding mortality hazard in this population.
His talk ‘Survival in Older Life with Diabetes – Variations on the Bottom Line’ concluded that guidelines should consider more dynamic risk models as well as individualisation in relation to glycaemic control.
To view the new international guideline, click here.