Researchers Identify Issues Facing Older Adults Living with Diabetes

The Diabetes UK teams developed eight priority questions and recommendations to improve the quality of life and care of older adults with diabetes.

The number of older adults living with diabetes is on the rise, and geriatricians are constantly experiencing difficulties providing care for these patient populations. The challenges may stem from the fact that most older adults do not just have diabetes, but are likely to have hypertension, chronic renal disease, or other non-diabetes-related illness such as osteoarthritis and chronic pains from other problems. The influence of ageism on health outcomes has become apparent, but older people’s care is typically not a focus for funding or study. The Research Steering Groups of Diabetes UK have chosen eight priority research areas that will aid in the resolution of diabetes-related challenges that affect older people. 

This study was conducted to identify significant research questions whose answers could help older persons with diabetes receive better treatment, and make specific recommendations for researchers and research funders on best addressing them. The researchers held several online research workshops that brought together a diverse group of people with diabetes and an established group of academic and clinical professionals to recommend areas for future research. The workshop began with 59 people in attendance, with three sessions to allow participants to discuss and identify areas requiring change. ‘What are some of the wicked challenges we should be thinking about solving?’ and’ How do you see research making a difference?’ were two questions that required responses from the groups. During the workshop, the team created eight priority research questions and cross-cutting areas of interest to guide the optimal care for older individuals with diabetes:

• How can we improve our understanding of the characteristics of older people living with diabetes and their outcomes, and can this deliver better person-centered care?  
• How are services for older people living with diabetes currently delivered, both for their diabetes and other conditions? How can we optimize and streamline the process and ensure everyone gets the best care tailored to their individual needs?  
• What tools might be used to evaluate the levels of understanding of diabetes in the older population amongst non-specialist healthcare professionals? 
• How can virtual experts or centers most effectively provide access to specialist multi-disciplinary team expertise for older people living with diabetes healthcare professionals caring for them?  
• Is a combination of exercise and a nutrition-dense, high-protein diet effective in preventing the adverse effects of type 2 diabetes and deterioration in frailty, and how might this be delivered in a way acceptable to people with type 2 diabetes?  
• How might we best use continuous glucose monitoring in older people and those who require support?  
• How can older people living with diabetes be better empowered to manage their diabetes in their own home, mainly when living with additional long-term conditions? 
• What are the benefits of peer support models for older people living with diabetes, both when living independently and when in care?  

Each of the questions was thoroughly analyzed by the researchers. One of the recommendations was the need to shift diabetic care to patient-centered care to allow health professionals to focus on individual needs and preferences when caring for older adults with diabetes. Also, to understand their requirements and determine how services should evolve to accommodate them. 

According to this study, more than one million individuals in the UK with diabetes are over the age of 65. However, getting older can make diabetes even more difficult because it increases complications, including heart attacks and strokes. More investment in research and educating how best to give care will be required to adequately address this issue, ensuring that older patients living with diabetes can remain independent for as long as possible while maintaining a high quality of life. Setting priorities, keeping things simple, and ensuring that appropriate therapy is offered is crucial to reducing morbidity and improving the quality of life for older adults living with diabetes. 

Practice Pearls: 

• Care for elderly adults with diabetes was recognized as a research priority during research prioritization processes. 
• Eight priority questions were identified, together with explicit suggestions for the research needed to address each. 
• This study provides Patient Living With Diabetes with supported ideas for new research that could enhance diabetes care. It urges the research community and funders to include them in future research programs and strategies. 

Wylie TAF, Morris A, Robertson E, et al. Ageing well with diabetes: A workshop to co‐design research recommendations for improving the diabetes care of older people. Wiley Online Library. https://onlinelibrary.wiley.com/doi/full/10.1111/dme.14795. Published February 4, 2022.  

Betsy Adegborioye, PharmD Candidate 2022, South College School of Pharmacy