Quality care is needed for older people with diabetes in care homes—now and for the future

As an older person living with diabetes, I am apprehensive about the current and future care of older people with diabetes in UK nursing and residential care homes. This is an area that has been neglected over the years.1 It worries me that I may have to rely on untrained carers who may not fully understand my personal diabetes management, especially use of diabetes technology. I fear my diabetes could be poorly managed and controlled because of staff members’ lack of knowledge. There is an urgent need to ensure safe, quality care for older people with diabetes in care homes and to improve carers’ skills in daily diabetes management and the use of diabetes technology.

Over a third of the 5.6 million people with diabetes in the UK are over the age of 65.23It is likely that because of the complications of aging they may need to be cared for through supported living in the community or in nursing or residential care homes. It’s estimated that one in four people in UK care homes have diabetes.4

There is a need for up-to-date audits and research relating to older adults with diabetes both in and out of care homes. The current lack of evidence based guidance is a substantial limitation to current approaches to care.5 Most large randomised clinical trials of treatments for diabetes exclude older people who are frail.6

The prevalence of frailty in people with type 1 diabetes as they reach older age is unknown.7 Speaking at the Diabetes UK Professional Care conference in April 2024, Jonathan Golding of University Hospitals Sussex NHS Foundation Trust discussed the lack of meaningful research into older adults with type 1 diabetes and frailty and explained the problem of research conflating different diabetes types.8 Including this cohort in research is crucial, as without their participation, critical insights that can inform better care and tackle challenges effectively may be missed.

One good example of research is the Task and Finish Group of Diabetes UK (2011), led by Alan Sinclair, which published a review of the original British Diabetic Association guidance on diabetes in care homes from 1999. Diabetes UK hoped that the resulting “Good clinical practice for care home residents with diabetes” guidelines would represent a national policy of good clinical practice for diabetes care within care homes.9 Despite this, there has been a lack of progress in implementing this guidance1 and care remains fragmented.10

Another key piece of research is the first England-wide audit of diabetes in care homes in 2012-13.11 In his foreword Sinclair said, “In many cases, older people with diabetes in care homes are suffering unnecessarily and even dying prematurely.” The audit highlighted a lack of comprehensive assessment, monitoring, and specialist care. It found that almost 65% of care homes had no diabetes screening policy, over 63% had no nominated member of staff with designated responsibility for diabetes management, and almost 48% were unaware of the Diabetes UK national guidelines. Most concerningly, over 17% admitted that they had no system to check whether people who self-medicate for diabetes had taken their medication. This is all very concerning. At present it is pure luck that a person with diabetes will end up in a care home that follows the Diabetes UK national guidelines and where carers are trained and have sufficient knowledge about diabetes to give safe care.

In 2016, Swale Clinical Commissioning Group trialled an education model based on the Trend framework13 to improve nurses’ skills in diabetes care and delegation of insulin administration.12 This trial had good competency outcomes and resulted in a reduction in hospital admissions and calls to emergency services,14 showing the importance of education. By 2018 the Eden team (part of the Leicester Diabetes Centre) had developed a national digital learning education programme for qualified and unqualified care home staff. This developed into Sanofi Care,15 which offers funded places delivered by Eden and endorsed by Skills for Care. Training of care home staff is paramount to giving safe, quality care to people with diabetes.

Eden is mentioned in the strategic document on diabetes care in care homes produced byt the National Advisory Panel on Care Home Diabetes in 2022.16 This document should be the definitive standard of care for older people with diabetes in care homes. Staff training in all care homes is essential to implementing the beneficial changes these documents contain to ensure the successful provision of education to enable safe and high quality diabetes care for older residents in care homes now and in the future.

But this demands nationwide stakeholder involvement, including owners and managers of all care homes. So, let’s start this process to make a meaningful difference to older people with diabetes living in care homes. Not in a decade’s time, but now.