Transferring elderly type 2 patients to insulin: a prospective study of diabetes nurses', physicians' and patients' perceptions

Taylor, Carolin; Towse, K; Reza, Mohammad Irshad; Ward, J. D.; Hendra, T. J.

doi:10.1002/pdi.326

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Patients often rank well-being or quality of life as the goal of switching to insulin above improvements in glycaemic control and avoidance of complications. 28 Attitudes will be affected by historical attitudes towards starting insulin as a 'failure' on their part, concerns about how their relatives and friends will view the treatment, and the possibility that they will be alone in the community without support to cope with needles and the risk of hypoglycaemia. Interactions with other older people who have started insulin, and their relationship with the healthcare team may also be important.…”

Section: Attitudes Of Patients Towards Starting Insulinmentioning

confidence: 99%

Review: Diabetes and insulin therapy in older people

Hendra

2005

Diabetes & Vascular Disease

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Concerns about hypoglycaemia, plus lack of evidence of benefit, contributed to underutilisation of insulin for older people with type 2 diabetes in the past. Following the UKPDS it is clear that many elderly patients treated with diet and oral antidiabetic agents will develop beta-cell failure and will be at risk of worsening glycaemic control with reduced well-being unless insulin is considered. Following diabetes diagnosis, the mainstay of treatment will be dietary control and exercise together with management of cardiovascular risk factors. When glycaemic control deteriorates oral agents will be needed. However, whereas in the past insulin was seen as a last resort for older type 2 patients there is support for considering its early use in selected older people with preserved cognitive function and poor glycaemic control, as well as for frail older people with weight loss and poor quality of life. The regimens of choice may include a combination of basal insulin with oral agents or twice-daily combinations of premixed short and intermediate acting insulin. The development of insulin analogues with their associated reduced risk of hypoglycaemia may also herald a new era of insulin treatment for older people.

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Section: Attitudes Of Patients Towards Starting Insulinmentioning

confidence: 99%

Review: Diabetes and insulin therapy in older people

Hendra

2005

Diabetes & Vascular Disease

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“…Equally, common comorbidities in older people, such as arthritis and depression [ 8 ], can cause further difficulties with self-care. Relatedly, concerns regarding the capacity of older people to administer insulin and accurately self-monitor blood glucose can lead professionals to delay insulin initiation in this population [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of the experiences of insulin use by older people with type 2 diabetes mellitus

Langerman,

Forbes,

Robert

2024

BMC Prim. Care

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Background There is a rising prevalence of type 2 diabetes among older people. This population also suffers from co-morbidity and a greater number of diabetes related complications, such as visual and cognitive impairment, which can potentially affect their ability to manage insulin regimens. Understanding the experiences of older people when they transition to insulin will help the development of healthcare interventions to enhance their diabetes outcomes, overall health and quality of life. Aims The aims of this exploratory study were to (1) understand the experiences of older people with type 2 diabetes in relation to insulin treatment initiation and management and (2) use this understanding to consider how the insulin management support provided to older people by healthcare providers could be more tailored to their needs. Method A qualitative study using semi structured (remote) interviews with older people with diabetes (n = 10) and caregivers (n = 4) from the UK. Interviews were audio recorded and transcribed, and framework analysis was used to analyse the data. Results Three main themes, along with six subthemes, were generated from the study data. Participants generally felt at ease with insulin administration following training, yet some reported feelings of failure at transitioning to insulin use. Participants were also frustrated at what they perceived were insufficient resources for effective self-management, coupled with a lack of professional interest in optimising their health as older people. Some also expressed dissatisfaction regarding the brevity of their consultations, inconsistent information from different healthcare professionals and poor treatment coordination between primary and secondary care. Conclusion Overall, the study emphasised that older people need better support, education and resources to help manage their insulin use. Healthcare professionals should be encouraged to adopt a more individualised approach to supporting older people that acknowledges their prior knowledge, physical and psychological capabilities and motivation for diabetes self-management. In addition, better communication between different services and greater access to specialist support is clearly needed for this older population. Practice implications An integrated care pathway for insulin use in older people could be considered. This would include an assessment of the older person’s needs and capacity on their initiation to insulin; targeted education and training in self-management; timely access to appropriate emotional and peer support resources; care plans developed collaboratively with patients; and individualised glucose targets that recognise the needs and preferences of the older person.

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“…In particular, age-related factors such as reduced vision, impaired mobility and dexterity may impact on the ability of an older person to follow their insulin regimens. Management can also be compromised by impaired cognitive function, sensory deficits, and a reliance on others over meal timing [8]. However, it is important that older people can successfully manage insulin use in order to reduce the occurrence of hypoglycaemia which can increase the risk of falls [9][10][11] and is associated with worse health outcomes [12].…”

Section: Introductionmentioning

confidence: 99%