Improved Care and Support for Older People with Diabetes
Submitting InstitutionUniversity of Bedfordshire
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
The work of IDOP has resulted in:
- Improved awareness of challenges posed by diabetes in older people
among NHS commissioners and service providers
- Greater recognition at national and international level of the
importance of frailty in diabetes
- Developing the growing national community network for practice and
- Publication of UK and European Guidelines for clinicians outlining
better standards of diabetes care and best clinical practice
- Improved service commissioning by creation and dissemination of
- Initiating major new national, European and global projects being
initiated, attracting considerable funds, and providing the platform for
enhanced diabetes care in older people (see www.instituteofdiabetes.org).
Professor Alan Sinclair — The Institute of Diabetes For Older People
(launched May 2008) www.instituteofdiabetes.org
— systematic investigation of 4 key areas in diabetes:
(1) British Care Homes
- First detailed prevalence study (27% - Sinclair AJ et al, Diabetes
Care 2001) including:
- Polypharmacy, high medication costs, inappropriate prescribing,
disability, functional loss, fragmented diabetes care, high mortality
- End of life care scenario among residents/risk for harmful adverse
drug reactions - insulin and oral glucose-lowering agents.
- With Royal Holloway College, London, validated first quality of life
measure (ADDQoL Senior, Diabet Med 2012) for aged subjects with
- Coventry Nursing Home study (Sinclair AJ et al, Br J Diab Vasc Dis
2012): first world-wide study to demonstrate patient-centred
benefits (quality of life, mood level, knowledge of diabetes) from a
- With IDDT, established a patient passport in care homes
(2) Diabetes and Disability
- Excess physical disability/reduced health status in older people with
diabetes; used predictive tool to evaluate mobility limitation (Sinclair
AJ et al, Diabetes Care 2008).
- Slower rate of cognitive decline in Alzheimer's Disease (AD) with
diabetes (Sanz C, Sinclair AJ et al 2009).
- That diabetes worsens functional status in those with a recent
diagnosis only (<1 year) of AD (Sanz C, Sinclair AJ et al, 2012).
- Reduced physical/mental health status in older people with diabetes
(Bourdel-Marchasson I, Sinclair AJ et al, Diab Res Clin Pract 2013;
First UK key paper series on diabetes and frailty: Sinclair et al,
Atienzar P, Br J Diab Vasc Dis 2012. Complements work from
DH-funded AWARE Study in Wales: in this area: visual loss,
Sinclair AJ et al, Age Ageing. 2000 Jul; 29(4):335-9; cognitive
dysfunction, Sinclair AJ et al, Diabetes Res Clin Pract. 2000
Dec; 50(3): 203-12.
(3) Diabetes and Medication Issues
Provided evidence of:
- inappropriate reasons by GPs for delaying treatment in type 2 diabetes
- significant delays in treatment in newly diagnosed older people with
diabetes (vs younger counterparts): UK GP database
- elevated HbA1c as the strongest factor associated with initiating
- education and counselling by community pharmacists can result in
improvements in the cardiovascular risk profile in type 2 diabetes (Ali
M et al. Diabet Med. 2012 Sep;29(9): e326-33) See (1) above:
(polypharmacy): awarded NIHR (RfPB) grant (2012) to research medication
issues in care home residents with diabetes.
(4) Work of IDOP-NHS Network to enhance Diabetes Care in England
2011 - established England-wide Network: Alan Sinclair appointed National
Clinical Lead for Diabetes in Older People: established 4 regional
clinical champions/steering groups addressing 6 key priorities per year/4
regional conferences (2012), national conference (2012 & 2013):
- Emphasised key roles of carers — Sinclair AJ et al, Diabet Med.
2010 Sep;27(9): 1055-9
- Led first National Care Home Diabetes Audit (with Royal Colleges, Age
UK, ABCD, DH, Diabetes UK — pre-launched in October 2013
- Established in 2012/13 series of focus groups/workshops — diabetes
education for care homes (East of England/Northamptonshire) (in press: Br
J Diab and Vasc Disease, 2013)
(5) Provided Platform for successful project applications:
National (a) DH grant (2010-current) — older people's diabetes
initiative/establish England-wide Network- approx £350k (b) NIHR award
(2012 ) - investigate hypoglycaemia in care homes — £207k ; (c)
Scleroderma Society — vasculitis/relationship to disorders including
diabetes - 2011 onwards — £125k.
International (a) multicentre EU (FP7):Co-Lead with Madrid
(2011-16) - MID-Frail Study- Diabetes/Frailty - 6 million
euros; (b) multicentre EU (FP7) (IDOP,work package lead (validating
frailty markers in diabetes) and AJS (Steering Group) — FRAILOMIC
(2012) - 12 million euros;
Major Pharma (a) Global Project — disseminate good clinical
practice in diabetes - £85k (b) Educational DVD: Patient Safety:
Diabetes/Cardiovascular Disease (JWA £30k) (c) DPP4-I audit in Primary
Care — £45k.
Key researchers at IDOP:
Professor Alan Sinclair: 0.5 fte (10/2005-12/2011), 0.8 fte (1/2012
onwards) Fractional appointments: Profs Roger Gadsby, Andrew Krentz, Mike
Kirby, Peter Scanlon, K Chakravarty; Stephan Anker, Leo R Manas; Jochen
Springer, Stephan von Haehling, Wolfram Doehner.
References to the research
3.1 Sinclair AJ, Conroy SP, Bayer AJ. Impact of diabetes on physical
function in older people. Diabetes Care. 2008 Feb; 31(2):233-5. Epub 2007
Nov 16 (Impact factor: 6.7 )
3.2 Sanz C, Andrieu S, Sinclair A, Hanaire H, Vellas B; REAL.FR Study
Group. Diabetes is associated with a slower rate of cognitive decline in
Alzheimer disease. Neurology. 2009 Oct 27;73(17):1359-66 (Impact factor:
3.3 Milligan FJ, Krentz AJ, Sinclair AJ. Diabetes medication patient
safety incident reports to the National Reporting and Learning Service the
care home setting. Diabet Med. 2011; 28 (12): 1537-40 (Impact factor: 2.9
3.4 Zhang Q, Marrett E, Jameson K, Meiler S, Davies MJ, Radican L,
Sinclair AJ. Reasons given by general practitioners for non-treatment
decisions in younger and older patients with newly diagnosed type 2
diabetes mellitus in the United Kingdom: A survey study. BMC Endocr
Disord. 2011 Oct 28; 11(1):17. (impact factor: 2.2)
3.5 Sanz CM, Hanaire H, Vellas BJ, Sinclair AJ, Andrieu S; REAL.FR Study
Group. Diabetes mellitus as a modulator of functional impairment and
decline in Alzheimer's disease. The Real.FR cohort. Diabet Med. 2012 Apr;
29(4):541-8. (Impact factor: 2.9 )
3.6 6. Gadsby R, Galloway M, Barker P, Sinclair A. Prescribed medicines
for elderly frail people with diabetes resident in nursing homes-issues of
polypharmacy and medication costs. Diabet Med. 2012 Jan; 29(1):136-9.
(Impact factor: 2.9 )
Details of the impact
1. Greatly improved awareness of the challenge and change in culture
at local, regional and national levels posed by diabetes in older people
— increases in web traffic; significant interest/attendance at IDOP/OPDN
national conferences, invited contributions by DH and Diabetes UK ,
membership of Parliamentary All Party Diabetes Think Tank,
published evidence of collaborative working (see section 3 below) and
participation in international scientific conferences.
2. A growing community of practice and learning
OPDN has > 500 members, features regular blogs/newsletters, is
vibrant, proactive and contributed to: Lancashire Social Services — add
only care homes with good diabetes care to approved list; validated
national screening tool for cognitive impairment in diabetes (Mini-Cog) —
Sinclair AJ et al, Diab Res Clin Pract 2013); Bexley network —
Pharmacists, service users, key clinicians enhanced medication reviews —
reduced dangerous and expensive over-prescribing ; OPDN created a suite of
information/ resources on NHS Diabetes website: www.diabetes.nhs.uk/networks/older_people_network/?#sg_anchor_
further information on the work of the network is summarised at
3. Creation of UK and European Guidelines providing better standards
of diabetes care and contributing to better practice.
Producing National Guidance in End of Life Diabetes Care (within Diabetes
UK, ABCD, TREND-UK, NHS Diabetes (available at www.diabetes.org.uk/About_us/Position-statements--recommendations/Position-statements/End-of-Life-Care-
/this was promoted & disseminated at the national Palliative Care
Conference (April 2013).
2013 : National Best Clinical Practice
Statement on Diabetes and Dementia with NHS Diabetes /TREND-UK, endorsed
by Diabetes UK, ABCD, Alzheimers Disease Society (available at www.instituteofdiabetes.org).
2011: European Diabetes Working Party on Older People (EDWPOP)
guidelines and Position Statement on diabetes care in older people
promoted across Europe: Diabetes Metab. 2011 Nov;37 Suppl 3:S27-38 (Impact
factor: 2.43) J Am MedDir Assoc. 2012 Jul;13(6):497-502 (IF: 4.7).
2010: Development of national guidance on diabetes in care homes
(Good Clinical Practice Guidelines - Diabetes UK 2010 - published: Diab
Medicine 201128(7):772-7 (IF: 2.9).
4. Improved service commissioning 2010/11 - with NHS Diabetes
published a Commissioning Document - 2000 hard copies printed and
disseminated, hundreds of online hits/downloads.
5. Major new national, European and global projects being initiated
and attracting considerable funds: led to enhanced reputation and
partnership working with DH, Diabetes UK, EU, and major pharma.
6. Dissemination of key findings (with recommendations): evidenced
by inclusion in guidance/publications: NHS - Department of Health/NHS
Diabetes, Diabetes UK, ABCD, TREND- UK, Royal Colleges, BGS, RCN, Social
care organisations including Age UK, European and International Diabetes
Societies and Geriatrics Societies, Insulin Dependent Diabetes Trust,
English Community Care Association.
Sources to corroborate the impact
5.1 carehome.co.uk, October 2013 - National diabetes care home survey
highlights `concerning' results
The first ever National Care Home Diabetes Audit revealed that over 60%
of the 2,043 premises surveyed did not have a designated member of staff
with responsibility for diabetes management. The audit was carried out by
the Institute of Diabetes for Older People (IDOP) in partnership with ABCD
(Association of British Clinical Diabetologists) and a group of other key
5.2 diabetes.co.uk, May 2013 — First clinical guidelines for
elderly diabetic care launched
New guidelines for doctors, nurses and care home managers who work with
or care for older people with type 2 diabetes have been released to ensure
older diabetic patients receive better care. The clinical European
guidelines the first for elderly diabetics - have been put together by the
Institute of Diabetes for Older People (IDOP) in an effort to address
current care issues, which include the high number of elderly diabetics
needlessly suffering serious complications due to a lack of proper care
and preventive treatment.
5.3 diabetesonthenet.com, March 2013 - Leading diabetes expert
receives international award
The Director of the Institute of Diabetes for Older People, Professor
Alan Sinclair, has been awarded the International Association of
Geriatrics and Gerontology Presidential Award for his work in improving
the care given to older people with diabetes. The award is the highest
honour in the field.
5.4 PR Newswire, March 2013 - Millions of Older People With Diabetes
Denied Proper Care
Older people with diabetes are needlessly developing devastating
complications because they are being denied proper care and aggressive
treatment. Professor Alan Sinclair, Director at Institute of Diabetes for
Older People (IDOP), said it was wrong that younger people were routinely
being given treatments that were denied to those who are older.
5.5 GP magazine, March 2013 - GPs urged to make diabetes 'ward rounds'
in care homes
GPs should visit local care homes each week to check for signs of
complications in elderly people with diabetes, according to the academic
behind the first guideline on care for older people with the disease.
Professor Alan Sinclair from the Institute of Diabetes for Older People
(IDOP) said weekly visits could pick up complications such as infections
and help to avoid hospital admissions.
5.6 Daily Mail online, March 2013
Older people with diabetes are suffering needless life-changing
complications, including amputations and blindness, because of
discrimination in favour of younger patients, a new report has warned. www.dailymail.co.uk/health/article-2288583/Older-diabetics-suffering-needless-
5.7 NHS Diabetes, July 2012 - Professor Alan Sinclair, National
Clinical Lead for Diabetes in Older People
Professor Alan Sinclair is our National Clinical Lead for Diabetes in
Older People and he has just started a new blog. In his monthly postings,
Alan will offer helpful suggestions about improving diabetes care for
older people which you will be able to take back to your teams.
5.8 Diabetes, January 2010 - A revision document prepared by a Task
and Finish Group of Diabetes UK Good clinical practice guidelines
for care home residents with diabetes: www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/Care-homes-0110.pdf
5.9 IDOP website, June 2012 - Older people network showcased at
A commitment to "prevent diabetes from becoming a barrier to successful
aging" was made at the parliamentary launch of the Older People Diabetes
Network. More than 60 people, including politicians, doctors and senior
managers, from as far afield as Spain and Scotland came to hear about the
network, launched by the Institute of Diabetes for Older People (IDOP) and
NHS Diabetes, on 18th June. Professor Alan Sinclair, Director of IDOP and
National Clinical Lead for Diabetes in Older People, said the network had
so far received "overwhelming support". Addressing delegates, he said:
"With focussed high-quality care being delivered across the country in
health and social care sectors we can prevent diabetes from becoming a
barrier to successful aging, which I hope all of us have as an ultimate
5.10 NHS Diabetes, June 2011, Commissioning Diabetes Services for
High-quality diabetes care for older people is provided by services which
actively identify and manage those individuals with diabetes who have
special needs as a result of extreme frailty, advanced age (>80y) or
residency within a care home. webarchive.nationalarchives.gov.uk/20130513172055/http://www.diabetes.nhs.uk/document.php?o