Improving outcomes for older people with diabetes

This article considers the practice nurse's approach to supporting older people to manage their diabetes. It is essential to individualise care and to interpret the older person's diabetes in the context of their overall health concerns, including reference to co-morbidities, cognitive function, lifestyle, social setting, and life expectancy (International Diabetes Federation, 2017; Hambling et al, 2019). The important subject of end-of-life care lies outside the scope of this article.

Maintaining safety and focusing on a person's quality of life and autonomy are important principles. Pharmacological treatment goals must be realistic, acknowledging the metabolic consequences of old age, the risks of hypoglycaemia and the dangers of polypharmacy. A holistic appraisal is crucial and primary care is well positioned to do this; practice nurses involved in diabetes care have an important role working alongside these patients.

There are increasing numbers of people with diabetes over the age of 65 years. This is principally driven by the rise in prevalence of type 2 diabetes (T2DM) that correlates with greater rates of obesity (increasing insulin resistance and declining pancreatic insulin secretion as a result of declining beta-cell function).