GPs urged to make diabetes 'ward rounds' in care homes

GPs should visit local care homes each week to check for signs of complications in elderly people with diabetes, according to the academic behind the first guideline on care for older people with the disease.

Academics warn older people with diabetes often miss out on treatments to prevent complications (Photo: iStock)
Academics warn older people with diabetes often miss out on treatments to prevent complications (Photo: iStock)

Professor Alan Sinclair from the Institute of Diabetes for Older People (IDOP) said weekly visits could pick up complications such as infections and help to avoid hospital admissions.

The IDOP guideline, the first such one for older people with diabetes in the UK, sets out clinical standards across 18 areas of care, including screening and diagnosis, prevention, complications, hypoglycaemia and falls.

Professor Sinclair said past guidelines 'ignored' the unique issues faced by older people with diabetes, such as frailty and loss of functional ability. He said there was a particular need to avoid hypoglycaemia.

But patients are often overlooked for aggressive treatment, leading to complications such as blindness and amputation, he said. 'It's a tragedy that so many elderly people suffer these complications when they could be so easily prevented if they were given the care and treatment that they need.'

'Personalised care'
Professor Sinclair told GP that practices could follow a model piloted in nursing homes in Birmingham. Once or twice a week, GPs assessed 'five or six' patients deemed at high risk of complications by qualified nursing staff. Patients can then be referred to a specialist if required.

Professor Sinclair said the approach could be rolled out more widely. 'It is a model that I think could be adapted. Certainly, once a week, targeting those at risk would be helpful - it doesn't have to be a very long meeting.

'What we know is that many nursing homes now are very much [caring for the] terminal phases of life, end of life scenarios, so that has to be weekly. Patients can rapidly decline, especially in diabetes.'

Professor Sinclair said reducing hospital admissions for diabetes in older people should be a key goal for primary care, but which would require close working with other parts of the NHS.

Dr Rowan Hillson, national clinical director for diabetes in England, said GPs needed to take more responsibility for their older patients with diabetes - particularly those in care homes.

She said: 'If you're a GP, you need to know who your older patients are, where they are, and are you looking after them in a care home, are you responsible for them?

'Have they actually had all the basic checks, the nine basic care processes that fall within the 15 essentials that Diabetes UK described? Have they had the appropriate basic checks for their general condition and their wishes?'

She added that care for older patients with diabetes needed to be personalised. 'It wont be appropriate for every single person to have every single check. You need to tailor the checks to the person, and tailor the treatment to the person and his or her wishes and needs.'

Professor Sinclair added: 'I think we all know that quite a bit of the medical care that is received is reactive, but nevertheless we also understand the considerable strain on primary care on delivering healthcare across the whole spectrum of patients.'

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