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Nurses urged to adopt pioneering guidance on treating diabetes in older patients

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Nurses are best placed to implement new guidance on caring for frail, elderly diabetes patients, one of its authors has told Nursing Times.

The guidance, drawn up by Dr David Strain at the University of Exeter and a range of other experts, aims to advise health professionals on getting the most out of the treatment options.

“Our consultations revealed that nurses tended to feel frustrated when they saw older adults being over-treated”

David Strain

Those behind it claim the document is the first guidance to set out how and when to stop diabetes treatments in patients who are too frail to benefit from being on certain treatments.

Dr Strain told Nursing Times that it takes 10-15 years for a patient to benefit from diabetes treatments and all of them have side effects attached.

As a result, in the case of extremely frail patients, treatment may harm quality of life before any improvement can be felt by the patient.

The new document is designed to guide clinicians through this conflict by setting out a simple guide to assessing frailty and modifying treatment targets, he said.

“Previous guidance said that treatment needs to be individualised but did not say how to assess which drugs will give the best quality of life,” said Dr Strain.

“We have now established guidance about which medications should and shouldn’t be given to different patients,” he said.

He suggested that nurses were usually better placed than doctors to make these decisions.

“They often get more time to talk to people with diabetes, so they have often been able to elicit potential complications of treatment that may get overlooked during shorter consultations with doctors,” he said.

However, he indicated that in the past they may have felt restricted by the available guidance.

“Our consultations revealed that nurses tended to feel frustrated when they saw older adults being over-treated in order to achieve the ‘one-size fits all’ targets embedded within the GP contract,” he said.

“We’re really pleased that these new guidelines will help healthcare professionals give this tailored support”

Pav Kalsi

The research was carried out in collaboration with NHS England and the findings and guidance was published last month in the journal Diabetic Medicine.

Much of the evidence for it came from Trisha Dunning, a nurse consultant in Melbourne, Australia, Dr Strain said.

The new guidance will be adopted across Devon and the authors hope it will later be incorporated into national guidance for GPs.

Pav Kalsi, senior clinical advisor at Diabetes UK, said: “People with diabetes rightly deserve to have access to the right care and support at every stage of their life, and that means the care they receive needs to be adapted and tailored to suit each individual’s changing needs.”

She welcomed the aim of the guidance to balance medical treatment with a consideration of quality of life.

“We’re really pleased that these new guidelines will, for the first time, help healthcare professionals give this tailored support and will help them review and decide whether to stop diabetes treatment for particularly frail adults,” she said.

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Readers' comments (1)

  • This is an excellent paper and I personally shall refer to it in relation to treating frail older people. It is so important to realise that one size does not fit all and that the aims of treatment differ at different points in the life course. We need to learn to balance risks and benefits and keep the patient at the centre of all we do. As our population ages it is more important that we combine the art and the science of nursing and medicine. Clinical guidelines need to take account of the needs and aspirations of older people especially those who are frail so that they experience the best possible quality of life. Here's the link to the paper

    https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13644

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