Diabetes in care homes: a cluster randomised controlled trial of resident education

Abstract

IntroductionResidents of care homes with diabetes are a vulnerable group, lacking comprehensive assessment, monitoring, and specialist access. This study aimed to determine whether a short-term patient centred intervention strategy might benefit people with diabetes living in residential care homes. MethodsResidents with diabetes were recruited and randomised (by care home) to intervention (25 homes: 57 residents) or control (26 homes: 45 residents). The intervention consisted of a medical review and individualised resident educational programme. The control group received usual care. Measures of glycaemic control (fasting glucose and HbA 1c ), quality of life, functional ability, cognition, mood, and diabetes knowledge were collected at baseline and after 6 months. ResultsAfter 6 months the intervention group, compared with control, had better quality of life, mood and diabetes knowledge and a slight increase in HbA 1c from a mean value of 6.84 % (1.54) to 7.49 % (1.82). Reports of hypoglycaemia were less at the end of the study in both groups. ConclusionsThe intervention improved patient-centred outcomes, with a small effect on glycaemic control. More research needs to be performed with care home residents to develop the evidence base for appropriate interventions in this neglected group of patients. Br J Diabetes Vasc Dis 2012;12:238-242.

Diabetes care for the most vulnerable in society – the views of professionals working in care homes and domiciliary care using focus group methodology

“…Recently a National Care Home Diabetes Audit has been set up by the Institute of Diabetes for Older People (IDOP) 9 and a number of diabetes education programmes have been developed specifically for staff in care homes. 10,11…”

Depression in the elderly with type 2 diabetes mellitus

“…A negative correlation between depression and diabetes education frequency in older patients was also described in the literature [21]. Research conducted on rest home boarders showed a positive influence of diabetes education on patients' well-being as well as a decrease of depression symptoms and less frequent hypoglycemia occurrence [24]. It is worth mentioning that patients' physical and mental well-being, concomitant diseases as well as vision and hearing impairment should be taken into consideration in the diabetes education process [23].…”

Failing to meet the needs of generations of care home residents with diabetes: a review of the literature and a call for action

“…The paucity of controlled studies in this area is obvious but themes of the importance of individualized care focusing on avoiding hypoglycaemia rather than tight glycaemic control are clear (37)(38)(39). Several studies based on providing education to the health professionals providing care showed benefits in reduction of hypoglycaemia, quality of life and mood (38,39), and the lack of management consistent with current clinical guidelines (40)(41)(42) highlight the need for better education of those providing care to residents with diabetes living in long-term care institutions. A six-month pilot initiative which evaluated the feasibility of a telemedicine approach to improve diabetes care of residents (91% were on insulin) in a skilled nursing facility involved weekly/biweekly teleconsultations between an endocrinologist and a nurse and dietitian (43).…”

“…Table 1 lists a number of studies and two literature reviews looking at various interventions in residents of long-term care facilities. The paucity of controlled studies in this area is obvious but themes of the importance of individualized care focusing on avoiding hypoglycaemia rather than tight glycaemic control are clear (37)(38)(39). Several studies based on providing education to the health professionals providing care showed benefits in reduction of hypoglycaemia, quality of life and mood (38,39), and the lack of management consistent with current clinical guidelines (40)(41)(42) highlight the need for better education of those providing care to residents with diabetes living in long-term care institutions.…”