"Millions of Older People With Diabetes Denied Proper Care"

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Institute of Diabetes for Older People (IDOP)

06 Mar, 2013, 00:01 GMT

LONDON, March 6, 2013 /PRNewswire/ --

Older people with diabetes are needlessly developing devastating complications because they are being denied proper care and aggressive treatment. Professor Alan Sinclair, Director at Institute of Diabetes for Older People (IDOP), said it was wrong that younger people were routinely being given treatments that were denied to those who are older.

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Serious complications of diabetes include diabetic retinopathy - the leading cause of blindness in the UK - nerve damage, kidney disease, heart disease and even the need for the amputation of limbs.  In the last few years there has been a huge increase in avoidable complications in retinopathy (118%), stroke (87%), kidney failure (56%) and cardiac failure (43%).[1] It is estimated that of more than 100 amputations carried out each week from diabetes complications,[2] up to 80% are preventable[3].

Over half (54%)[4] of Britain's 3.8 million[5] people with diabetes are 60 or over and people in this age group are most at risk of complications of the disease, and it is estimated that by 2030 the number of people with diabetes in the UK over 60 will increase to 60%.[3] Yet Professor Sinclair warns that, while younger people with diabetes are routinely offered 'aggressive treatments' to prevent these complications, older people often get overlooked.

"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," said Professor Sinclair.

Currently older patients with diabetes complications occupy 15%[6] of all hospital beds and Professor Sinclair predicts that by 2030 this figure will rocket to one in four hospital beds, costing taxpayers £465.25 million per year (due to 1.34 million diabetes bed days).[7]

"If nothing is done now to improve the care of older people with type 2 diabetes, the effect on patients and the NHS could be catastrophic - the impending diabetes time bomb could potentially bankrupt the already stretched service," he added.

To address these issues and ensure older patients with type 2 diabetes receive better care, IDOP has today launched the 'European Diabetes Working Party for Older People 2011 Clinical Guidelines for Type 2 Diabetes Mellitus (EDWPOP)' - a set of user-friendly recommendations for doctors, nurses and care home managers who work with or care for older people with diabetes.

The EDWPOP guidelines have been developed to address care gaps highlighted in a 'Position Statement' developed by the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP) and the International Task Force of Experts. The Position Statement identified a need for specific guidelines as previous guidelines did not focus on the needs of older people.

The collaborative expert group explored the key issues that affect diabetes in older people using a rigorous consensus approach, along with an evidence-based review of literature. Gaps in care identified include:[8]

  • The use of exercise-, nutrition-, and glucose-lowering therapies in the effective management of type 2 diabetes in older people
  • Practical community-based interventions to reduce hospitalisation
  • Methods to decrease hypoglycaemia rates in various clinical settings
  • Health economic evaluations of metabolic treatment
  • Interventions to delay/prevent diabetes-related complications that are important in older age, such as cognitive impairment and functional dependence
  • Development of technical devices that help to maintain autonomy and safety for older people with diabetes

"In the past some clinical guidelines have ignored the issues faced by older people with diabetes such as frailty, functional ability and increased dependency, focusing mainly on the needs of the young, and consequently older people have missed out on preventive treatments and suffered blindness and limb amputation as a result in some cases," says Prof Sinclair.

The EDWPOP  guidelines provide:  

The EDWPOP guidelines provide an evidence-based and detailed summary of what healthcare professionals across Europe should be doing now to give patients the best diabetes care possible. They include:

  • An evidence-based review of treatment for older people with diabetes, intended as a resource for clinical decision-making
  • A user-friendly set of recommendations for primary care, the community and secondary care settings
  • Guidance in 18 areas of clinical interest, such as screening and diagnosis, prevention, secondary complications, hypoglycaemia, cognitive impairment, falls and immobility

Notes to Editors:

About EDWPOP

The original European Diabetes Working Party for Older People (EDWPOP) was established in December 2000 to ensure that older people in societies across the European Union have consistent and high-quality diabetes care throughout their lives

About IDOP

Institute of Diabetes for Older People (IDOP) is a non-profit making, research and academic institution, based at the University of Bedfordshire, dedicated to enhancing the health and well-being of all older people with diabetes and related metabolic illness.

For more information about IDOP visit: http://instituteofdiabetes.org.

Prevalence of diabetes in the UK

Diabetes has quickly become one of the most concerning health epidemics in the UK.  Already £9.8[9] billion is spent on diabetes care in the UK every year with 79%[10] of the NHS budget spent on managing and treating potential preventable complications associated with diabetes.

  • In 2011, there were 3.8 million people diagnosed with diabetes (90% Type 2).[5]
  • The UK average prevalence in adults is nearly 4.5% or over one in 20.[11]
  • It is estimated that there are another 850,000 people who are undiagnosed.[12]
  • By 2035, it is estimated there will be 6.3 million people with diabetes in the UK.[5]
  • Diabetes increases with age. In older age groups the prevalence is nearly double that of younger groups.[13]
  • People with diabetes stay longer in hospital. In the UK this is estimated to be an additional excess 288,000 bed days per year[14],[15]costing an estimated £82.5 million per year.[4]
  • People with diabetes in hospital are older than other patients, with a median age of 75 years compared to 67 years for all in-patients.[6]  


References

1. Derived from the QOF Diabetes registers and NDA diabetes-related complications prevalence in the years 2006-2010. The figures represent percentage of increase in the estimated number of people with complications, provided that the NDA complications prevalence rates were reflected among the people diagnosed with diabetes on the QOF registers

2. Based on the number of inpatient episodes where amputations occurred in the period (2007-2010) and there was a diagnosis of diabetes. Source: Diabetes Footcare Activity Profiles http://www.yhpho.org.uk/default.aspx?RID=116836

3. NHS Right Care. (2011). NHS Atlas of Variation in Healthcare. Available: http://www.rightcare.nhs.uk/index.php/atlas/atlas-of-variation-2011.

Last accessed 24th April 2012

4. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diab Res Clin Prac 2010;7:4-14

5. Hex N, Barlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the United Kingdom, including direct health costs and indirect societal and productivity costs. Diab Med 2012;in press.

6. NHS Diabetes. Summary Findings from the National Diabetes Inpatient Audit (NaDIA) 2010 (England).

7. NHS Diabetes, National Institute for Innovation and Improvement. Improving emergency and inpatient care for people with diabetes. 2008.

8. Diabetes Mellitus in Older People: Position Statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. Sinclair A, Morley J, et al. July 2012. http://www.jamda.com/article/S1525-8610(12)00131-4/fulltext

9. Diabetes UK. Last Accessed 28/02/13. http://www.diabetes.org.uk/About_us/News_Landing_Page/NHS-spending-on-diabetes-to-reach-169-billion-by-2035

10. Diabetes UK. Last Accessed. http://www.diabetes.org.uk/About_us/News_Landing_Page/NHS-spending-on-diabetes-to-reach-169-billion-by-2035  

11. Quality and outcomes framework (QOF) 2011. England: http://bit.ly/qof2011e ; Northern Ireland: http://bit.ly/qof2011ni ; Scotland: http://bit.ly/qof2011s ; Wales: http://bit.ly/qof2011w .

12. Figure based on data from AHPO diabetes prevalence model figures http://bit.ly/aphodiabetes and the QOF 2010 figures http://bit.ly/prevalence2010.

13. The Information Centre (2011). Health Survey for England 2010 http://bit.ly/HSE2010.

14. Sampson MJ, Doxio N, Ferguson B, et al. Total and excess bed occupancy by age, speciality and insulin use for nearly one million diabetes patients discharged from all English acute hospitals. Diab Res Clin Prac 2007;77:92-8.

15. Sampson MJ, Crowle T, Dhatariya K, et al. Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service. Diab Med 2006;23:1008-15.