Diabetes in the Elderly

Helen LockettConsultant RD+E

Medals

• NABARRO – 50 years (2014 – 471 awarded)• LAWRENCE – 60 years• MACLEOD – 70 years (>100 awarded since 2004)

Mortality (Scotland)

• Compare 20yo with and without T1DM

MenLife expectancy

Women

With T1DM 66 68

Without 77 81

Golden Years Study

• People with Nabarro medal 1993-1996• 581 medals / 145 per year• 400 took part • Age 68.9 +/- 8.5years (SD)• Age onset 13.7 +/- 7.3years• Only 29% on antihypertensive• Mean HbA1c 7.6%

Golden Years Study Findings

• Identifiers of long-survival T1DM– Reasonable HbA1c– High HDL– Normal body weight– Insulin sensitive (on low doses)– Non-smokers– Normal ACR after 15-20 years– FH of longevity

• Patients’ main fear is hypos

DUK recommendations for Management of Diabetes in Care Homes

• Individualised care plan with annual assessment of vision, cognition and nutrition

• Home to have Policies for management of diabetes

• Access to staff training• Care plan agreed by patient, GP and home

Audit in England in 2012-13

• 49000 residence audited• 10.4% diabetes (mostly type 2)• 33% staff no access to education• 37% no policy for managing hypos

What is different about Diabetes Management in

the Elderly?

Patient’s PerspectiveDoctor’s Perspective

Torbay Guidelines

• Life-expectancy <5 years are unlikely to benefits from tight glycaemic control or tight BP control.

• Aims of treatment for patients who are very frail – To avoid hypoglycaemia – To control symptoms and avoid metabolic complications – To reduce risk of infection – To avoid hospital admission – To introduce timely end-of-life care.

Reading

• DUK website – Guidance in management of diabetes and dementia– TREND UK (training, research and education for

nurses in diabetes)– IDOP (Institute of diabetes for older people)