References

Bowman L, Mafham M, Wallendszus K Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018; 379:(16)1529-1539 https://doi.org/10.1056/NEJMoa1804988

Buse JB, Wexler DJ, Tsapas A 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2020; 63:(2)221-228 https://doi.org/10.1007/s00125-019-05039-w

Cheng G, Huang C, Deng H, Wang H Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012; 42:(5)484-491 https://doi.org/10.1111/j.1445-5994.2012.02758.x

Davies MJ, D'Alessio DA, Fradkin J Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018; 61:(12)2461-2498 https://doi.org/10.1007/s00125-018-4729-5

Diabetes UK. Complications. 2021. https://www.diabetes.org.uk/guide-to-diabetes/complications/hypos (accessed 10 June 2021)

Diggle J Tacking hypoglycaemia in type 2 diabetes. Diabetes and Primary Care. 2015; 17:44-47

Dormandy JA, Charbonnel B, Eckland DJ PROactive investigators. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive study: a randomised controlled trial. Lancet. 2005; 366:1279-1289 https://doi.org/10.1016/S0140-6736(05)67528-9

Duggan SN, Conlon KC Pancreatogenic Type 3c Diabetes: Underestimated, underappreciated and poorly managed. Pract Gastroenterol. 2017; 5:14-23

Farmer AJ, Brockbank KJ, Keech ML, England EJ, Deakin CD Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabet Med. 2012; 29:(11)1447-1450 https://doi.org/10.1111/j.1464-5491.2012.03657.x

Ferrannini E Insulin resistance versus insulin deficiency in non-insulin-dependent diabetes mellitus: problems and prospects. Endocr Rev. 1998; 19:(4)477-490 https://doi.org/10.1210/edrv.19.4.0336

Forbes A, Murrells T, Mulnier H, Sinclair AJ Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018; 6:(6)476-486 https://doi.org/10.1016/S2213-8587(18)30048-2

Fralick M, Schneeweiss S, Patorno E Risk of diabetic ketoacidosis after initiation of an SGLT-2 inhibitor. N Engl J Med. 2017; 376:(23)2300-2302 https://doi.org/10.1056/NEJMc1701990

Gadsby R Diabetes care for older people. A practical view on managements. Diabetes and Primary Care. 2018; 20:27-37

Hambling CE, Khunti K, Cos X Factors influencing safe glucose-lowering in older adults with type 2 diabetes: a position statement of Primary Care Diabetes Europe. Primary Care Diabetes PCDE. 2019; 13:(4)730-752

Hambling C How to manage diabetes in later life. Diabetes and Primary Care. 2020; 22:(1)5-6

Heller SR Hypoglycaemia. Its pathophysiology in insulin treated diabetes and hypoglycaemic awareness. Diabetes and Vascular Disease. 2011; 11:(1)6-11 https://doi.org/10.1177/1474651410397248

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359:(15)1577-1589 https://doi.org/10.1056/NEJMoa0806470

International Diabetes Federation. Managing older people with type 2 diabetes. 2017. https://www.idf.org/e-library/guidlines/78 (accessed 10 June 2021)

Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA. 2014; 312:(24)2668-2675 https://doi.org/10.1001/jama.2014.15298

Inzucchi SE, Bergenstal RM, Buse JB Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015; 38:(1)140-149 https://doi.org/10.2337/dc14-2441

Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015; 38:(2)316-322 https://doi.org/10.2337/dc14-0920

Maraldi C, Volpato S, Penninx BW Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med. 2007; 167:(11)1137-1144 https://doi.org/10.1001/archinte.167.11.1137

Naik RG, Palmer JP Latent autoimmune diabetes in adults (LADA). Rev Endocr Metab Disord. 2003; 4:(3)233-241 https://doi.org/10.1023/a:1025148211587

National Institute for Health and Care Excellence. CG181 Cardiovascular disease: risk assessment and reduction, including lipid modification. 2014. http://www.nice.org.uk/guidance/cg181 (accessed 10 June 2021)

National Institute for Health and Care Excellence. NG28 Type 2 diabetes in adults: management. 2015a. http://www.nice.org.uk/guidance/ng28 (accessed 10 June 2021)

National Institute for Health and Care Excellence. NG17 Type 1 diabetes in adults: diagnosis and management. 2015b. http://www.nice.org.uk/guidance/ng17 (accessed 10 June 2021)

National Institute for Health and Care Excellence. NG136 Hypertension in adults: diagnosis and management. 2019. http://www.nice.org.uk/guidance/ng136 (accessed 10 June 2021)

National Institute for Health and Care Excellence. CKS Scenario: Antiplatelet treatment for primary prevention of cardiovascular disease. 2020a. https://cks.nice.org.uk/topics/antiplatelet-treatment/management/primary-prevention-of-cvd/ (accessed 10 June 2021)

National Institute for Health and Care Excellence. CKS Scenario: Antiplatelet treatment for secondary prevention of cardiovascular disease. 2020b. https://cks.nice.org.uk/topics/antiplatelet-treatment/management/secondary-prevention-of-cvd/ (accessed 10 June 2021)

Palladino R, Tabak AG, Khunti K Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes. BMJ Open Diabetes Res Care. 2020; 8:(1) https://doi.org/10.1136/bmjdrc-2019-001061

Pearson S, Kietsiriroje N, Ajjan RA Oral semaglutide in the management of type 2 diabetes: a report on the evidence to date. Diabetes Metab Syndr Obes. 2019; 12:2515-2529 https://doi.org/10.2147/DMSO.S229802

Schwartz AV, Hillier TA, Sellmeyer DE Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002; 25:(10)1749-1754 https://doi.org/10.2337/diacare.25.10.1749

Scottish Intercollegiate Guidelines Network. Pharmacological management of glycaemic control in people with type 2 diabetes. 2017. http://www.sign.ac.uk/media/1090/sign154.pdf (accessed 10 June 2021)

Solomon CG Reducing cardiovascular risk in type 2 diabetes. N Engl J Med. 2003; 348:(5)457-459 https://doi.org/10.1056/NEJMe020172

Improving outcomes for older people with diabetes

02 July 2021
12 min read
Volume 32 · Issue 7

Abstract

Older people with diabetes have unique challenges. David Morris discusses the importance of individualising care for this group of people

An individualised approach aiming to maximise safety, preserve autonomy and improve quality of life is needed when helping an older person to manage their diabetes. It is important 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, and practice nurses are well placed to work in partnership with people with diabetes to achieve this. Pharmacological treatment goals must be realistic, acknowledging the metabolic consequences of old age, the risks of hypoglycaemia and the dangers of polypharmacy.

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).

Register now to continue reading

Thank you for visiting Practice Nursing and reading some of our peer-reviewed resources for general practice nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month