Education
Family and Carer Forum
Diabetes in older people can be a complex disorder to manage and requires additional skills and competencies from health and social care professionals. Diabetes education is a fundamental part of this management of the older person with diabetes and it is now increasingly recognised that family members and informal carers often play a significant role in caring for older people with diabetes.
This requires a programme of education that meets the needs of carers and such a programme is likely to include knowledge about diabetes as a long-term condition, what is good glucose control, what lifestyle changes are important, food choices, and how the mindset of an older person with diabetes is likely to change after diagnosis. In addition, carers are likely to be aware that other conditions, sometimes called comorbidities, can influence diabetes management. We will be hoping to develop this part of our website to include guidance on providing knowledge of diabetes and other important information about diabetes in older people.
This Forum will facilitate exchanges of stories, enquiries, and other relevant material between carers and families.
DESMOND and older people
DESMOND is a nationally-recognised programme of education for people with type 2 diabetes. The acronym stands for ‘Diabetes Education and Self Management for Ongoing and Newly-Diagnosed’ diabetes. It is based on a six-hour, structured, self-management, self-education programme and should involved patients within twelve months of diagnosis.
The programme is often suitable for many older people with diabetes who can be accompanied at the educational session by their spouse or other family member. Sometimes the venue is at the hospital, but the meetings can also take place in the community. Apart from enhancing diabetes self-management skills, it is hoped that glucose control will improve, weight reduction will take place if required, and physical activity will increase. DESMOND training is also likely to produce behaviour change which is a crucial action if improvement in diabetes care is expected.
Best Clinical Practice
An important role for IDOP will be to identify and review examples of Best Clinical Practice (BCP) relating to diabetes care of older people both in the UK and abroad where feasible. This review process will be gauged against a strict set of criteria ( a framework of BCP that has organisational and clinical elements) developed by the IDOP Advisory Board with a strong emphasis on patient-centred outcomes such as enhancing quality of life and maintaining functional status. Innovative approaches to diabetes care that focus on good access to specialist services and educational support will be highlighted. Where appropriate BCP guidelines will be developed.
Three early phases to consider in developing the BCP approach are:
- Identification of areas of interest both organisational and clinical
- Devising data collection tools that are capable of use in different settings
- Developing the idea of risk-adjusted outcome measurement that allows BCP to be identified.
Examples of BCP are being actively compiled in partnership with NHS Diabetes. They will be available shortly on this website.
Patients’ stories
A patient’s experience of diabetes self-management
“I am a 74 year old Caucasian male; I live in South East London and am self-employed. Self management in diabetes is simply helping health professionals to control the condition in order to maintain a reasonable state of good health for as long as possible.
When I was diagnosed with type 2 diabetes in September 1998, it was not too much of a surprise as I had often felt very thirsty during the preceding year which I knew was a common symptom of the condition. I was then 62 which I understand is the average age for the onset of type 2 diabetes.
My GP prescribed Metformin tablets and I received good advice on sensible eating from the hospital nutritionist. At my general practice, the diabetes specialist diabetes nurse explained how to carry out finger-prick blood testing. Looking back, I think this was the point when I started to be involved in my own self-management by taking an active interest in controlling my diabetes.
I registered for a series of meetings organised by a local primary care trust on becoming an ‘expert patient’. The tutors on the short course were themselves people with chronic health conditions such as heart and breathing disorders and were ideally qualified to talk about self-management from their own experience. They discussed topics such as exercise, nutrition and weight, having a positive mental attitude and how to work with doctors and nurses in managing health conditions such as asthma and diabetes.
I have now got used to keeping an eye on my general health, making sure I continue taking the tablets, checking my blood sugar levels and keeping in touch with my GP and nurse for the vital HbA1c tests in order to keep to the traditional guidelines for diabetes control (a HbA1c of under 7%).
I am a member of Diabetes UK and have found reading Diabetes UK’s Balance magazine very helpful. I have also attended DUK network days with other members which gives an opportunity to talk to people with diabetes and to hear interesting talks on self-management. I do subscribe to the view that we are people with diabetes rather than passive diabetics. I am a member of the national Older People’s Steering Group for diabetes at NHS Diabetes as part of an England-wide initiative to improve the quality of care delivered – this work is led by IDOP.”
Philip Ivory
‘Self-management in diabetes is common sense; it’s what adults do anyway in their daily working and private lives. We become proactive, sharing responsibility for our condition in partnership with health professionals who look after us.’
Common problems experienced by older people with diabetes
A large number of older people with diabetes remain well and healthy, and experience active leisure pursuits and maintain a very high quality of life. However, some can suffer from a range of symptoms and common medical problems associated directly with their diabetes, including the effects of medication. These range from visual disturbances, hypoglycaemia, limb pain, and an increased risk of falls.
The IDOP Advisory Board has been tasked with producing in this section a list of these common problems and providing advice and guidance on how to manage them. This process has already started, and by mid-January 2012, five common problems will be considered. These will be: avoiding hypoglycaemia, foot care, eye care, dietary management, and use of insulin.
Please watch our film on this topic below.
Clinical Guidelines and other key resource documents
In this section, users of the website will soon be able to access the links to any relevant clinical guidelines of diabetes and high priority resource documents relevant to older people with diabetes. This section will be complemented by the Publications menu found on the Home page.
The recently-completed Executive Summary of the ‘European Diabetes Working Party for Older People 2011’ will be published in Diabetes & Metabolism as ‘Clinical Guidelines for Type 2 Diabetes Mellitus. Executive Summary’. These guidelines provide an opportunity to summarise the interpretation of recent clinical trial evidence for older people with diabetes. They are intended to support clinical decisions, and the primary focus is on enhancing high-quality diabetes care. The IAG-AMDA Position Statement will also be made available during early 2012.
It is the intention of the IDOP Advisory Board that a list of all key published documents involving older people with diabetes will be updated on a three-monthly basis. This will be compiled and supervised by Professor Roger Gadsby.