Abstract
INTRODUCTION:
We now face an increasing challenge of managing type 1 diabetes (T1DM) in older people. 3% of patients with T1DM are over 80 years old - a number that is set to rise over the coming decades. Diabetes is a risk factor for frailty, and advanced age comes with a higher incidence and severity of comorbidities affecting patients’ ability to manage their treatments, such as arthritis or dementia. A recent systematic search in England highlighted the scarcity of data surrounding this, finding no articles specifically researching frailty in older adults with T1DM.
CASE STUDY:
●90-year-old lady with T1DM
●Living alone with mild frailty
●Mild cognitive impairment
Despite living alone and being independent with many of her activities of daily living, her mild cognitive impairment made her unable to manage her insulin safely. Consequently, she had recurrent hospital admissions due to labile blood sugars. Local services (even in central Manchester) offer a maximum of two visits each day, which is not a safe insulin regime for most patients living with T1DM. As family were not available to support, she had prolonged inpatient hospital stays and ultimately had to explore 24-hour nursing care, despite being otherwise independent.
The case provides a poignant illustration of an issue which is only going to become more frequent as the early users of insulin now reach older age.