Managing diabetes in people with dementia: protocol for a realist review

Abstract

BackgroundWorldwide, the prevalences of diabetes and dementia are both increasing, particularly in older people. Rates of diabetes in people with dementia are between 13 and 20 %. Diabetes management and diabetic self-care may be adversely affected by the presence of dementia. There is a need to know what interventions work best in the management of diabetes in people living with dementia (PLWD) in different settings and at different stages of the dementia trajectory. The overall aim is to develop an explanatory account or programme theory about ‘what works’ in the management of diabetes in people in what context and to identify promising interventions that merit further evaluation.Methods/designThis study uses a realist approach including studies on the management of diabetes in older people, medication management, diabetes-related self-care, workforce issues and assessment and treatment. We will use an iterative, stakeholder driven, four-stage approach. Phase 1: development of initial programme theory/ies through a first scoping of the literature and consultation with key stakeholder groups (user/patient representatives, dementia-care providers, clinicians, diabetes and dementia researchers and diabetes specialists). Phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. Phase 4: actionable recommendations for the management of diabetes in PLWD.DiscussionA realist synthesis of the evidence will provide a theoretical framework (i.e. an explanation of how interventions work, for whom, in what context and why) for practice and future research work that articulates the barriers and facilitators to effective management of diabetes in people with dementia. By providing possible explanations for the way in which interventions are thought to work and how change is achieved, it will demonstrate how to tailor an intervention to the setting and patient group. The propositions arising from the review will also inform the design of future intervention studies.Systematic review registrationPROSPERO registration number CRD42015020625.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0182-4) contains supplementary material, which is available to authorized users.

Managing diabetes in people with dementia: a realist review

“…The outcomes we specified in the protocol for this synthesis included a number of clinical outcomes, such as the prevention of hypoglycaemia, the management of cardiovascular risk factors and the identification and management of long-term complications such as neuropathy. 1 However, the outcomes that emerged from the evidence available are primarily experiential rather than clinical, focusing on the need to trigger mechanisms such as trust, confidence and empowerment. A general metamechanism that emerges is that there is some form of synergy between an intervention strategy, disease progression and social and environmental factors (in particular the involvement of family members).…”

“…T his chapter includes text from the protocol, which was published by Bunn et al 1 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons. org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.…”

Why we're failing to tackle the twin challenges of diabetes and dementia

“…Up to 27% of nursing home residents have diabetes and many of these are frail, cognitively impaired or have other comorbidities. More­over, between 13% and 20% of people with dementia also have diabetes .…”

“…Up to 27% of nursing home residents have diabetes and many of these are frail, cognitively impaired or have other comorbidities. More­over, between 13% and 20% of people with dementia also have diabetes . Nevertheless, according to a recent survey, only 53% of care homes in England assessed residents’ knowledge of hypoglycaemia using a standard protocol.…”

“…Dr Bunn and colleagues aim to develop a theoretical framework that explains which interventions work, for which patients, in what context and why. The study also aims to identify ‘barriers and facilitators to effective management’ of PWDD . Dr Bunn argues that explaining how interventions work and the mechanisms that achieve change, will help tailor interventions to the setting and patient group .…”