Diabetes in the elderly

1. Diabetes in the
Elderly
Helen Lockett
Consultant RD+E

2. Medals
• NABARRO – 50 years (2014 – 471 awarded)
• LAWRENCE – 60 years
• MACLEOD – 70 years (>100 awarded since 2004)

3. Mortality (Scotland)
• Compare 20yo with and without T1DM
Men
Life
expectancy
Women
With T1DM 66 68
Without 77 81

4. Golden Years Study
• People with Nabarro medal 1993-1996
• 581 medals / 145 per year
• 400 took part
• Age 68.9 +/- 8.5years (SD)
• Age onset 13.7 +/- 7.3years
• Only 29% on antihypertensive
• Mean HbA1c 7.6%

5. Golden Years Study Findings
• Identifiers of long-survival T1DM
– Reasonable HbA1c
– High HDL
– Normal body weight
– Insulin sensitive (on low doses)
– Non-smokers
– Normal ACR after 15-20 years
– FH of longevity
• Patients’ main fear is hypos

6. DUK recommendations for Management of
Diabetes in Care Homes
• Individualised care plan with annual
assessment of vision, cognition and nutrition
• Home to have Policies for management of
diabetes
• Access to staff training
• Care plan agreed by patient, GP and home

7. Audit in England in 2012-13
• 49000 residence audited
• 10.4% diabetes (mostly type 2)
• 33% staff no access to education
• 37% no policy for managing hypos

8. What is different
about Diabetes
Management in
the Elderly?
Patient’s
Perspective
Doctor’s Perspective

10. Torbay Guidelines
• Life-expectancy <5 years are unlikely to benefits
from tight glycaemic control or tight BP control.
• Aims of treatment for patients who are very frail
– To avoid hypoglycaemia
– To control symptoms and avoid metabolic
complications
– To reduce risk of infection
– To avoid hospital admission
– To introduce timely end-of-life care.

12. Reading
• DUK website – Guidance in management of
diabetes and dementia
– TREND UK (training, research and education for
nurses in diabetes)
– IDOP (Institute of diabetes for older people)