Abstract
Introduction
Diabetes is a major health concern in the United Kingdom, contributing to both microvascular complications like nephropathy, etinopathy, and neuropathy, and macrovascular issues such as atherosclerosis, which can lead to stroke, myocardial infarction, and peripheral vascular disease. Older diabetic patients are particularly vulnerable due to frailty and multiple co-morbidities.
Improved prescribing and monitoring could enhance care for this population.
Methodology
We conducted a review of older diabetic patients (>75 years) by examining their drug charts and treatment regimes. Blood glucose levels, HbA1c levels, and fall risk assessments were evaluated to determine whether treatment targets were being met. Thirty-one patients met the inclusion criteria, and their treatment was categorized into three groups: insulin only, insulin with other hypoglycaemic agents, and hypoglycaemic agents alone. Diabetic specialist nurse (DSN) involvement was also reviewed.
Results
Of the 31 patients, 14 required a fall risk assessment during admission. Twenty-five patients had an HbA1c within
the target range. However, 29 patients had blood glucose levels outside the target range for their frailty. At discharge, 15 patients achieved the target blood glucose range, while 16 did not.
Conclusion
All patients had blood glucose checks within 48 hours of admission, but fewer than 50% had fall risk assessments. Despite nearly 70% receiving a comprehensive geriatric assessment, 94% had blood glucose levels outside the target range for their frailty. Around 20% had HbA1c levels above 69, and 50% did not meet target blood glucose at discharge. Only 25% were referred to DSNs. Improved glycaemic control may have been achieved with more DSN referrals.