Main Category: Diabetes
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One care home resident with diabetes is admitted to hospital every 25 minutes due to failings in screening and training, according to a new report[1] launched today by leading health charity Diabetes UK.
The report, 'Diabetes in care homes - Awareness, screening, training', found six out of ten care homes in England, which have residents with diabetes, fail to provide any training to their staff about the condition. The report also revealed less than a quarter (23 per cent) of care homes screen residents for diabetes on admission, and fewer than a third (28 per cent) screen for the condition on an annual basis. This missed screening means as many as 13,500[2] care home residents in the UK could have undiagnosed Type 2 diabetes[3] and be at increased risk of complications associated with condition such as heart disease, stroke, kidney failure, blindness and amputation.
Diabetes UK Chief Executive, Barbara Young, said: "These report findings are an indictment of the standards of diabetes care provided by a worrying number of our country's care homes. We estimate as many as a quarter of care home residents in England, around 56,000, have diabetes. To discover, therefore, that many homes fail to provide any training to their staff or screen for this common yet serious condition is truly alarming.
"With an ageing population and recent data showing no halt to the ever increasing numbers of those being diagnosed with Type 2 diabetes, older people particularly could face a bleak future of failing care. Even the most basic training and awareness can have a huge impact on improving the quality of life for thousands of society's most vulnerable people by preventing the complications of diabetes as well as reducing costs to the NHS."
Basic training for care home staff should include how to identify symptoms, recognise and treat hypoglycaemia ('hypos')[4], measure and monitor blood glucose levels, administer insulin safely, and understand the importance of dietary timings and requirements as well as regular physical activity.
More than half of care homes (54 per cent) felt the local authority could do more to provide encouragement, information and guidance to offer effective diabetes care, and nearly two thirds (62 per cent) of local authorities had not made an assessment of the needs of older people with diabetes in their area.
One care home manager stated that: "Never in four years of being a home manager has anyone from the local authority come in to/or contacted the home about diabetes", another that "[our] PCT refuses to provide training to nursing homes", and one home manager even stated diabetes care "is an NHS responsibility, rather than a social care one".
Diabetes UK is calling for care homes to implement the recommendations in its guidance document 'Good Clinical Practice Guidelines for Care Home Residents with Diabetes'[5]. This includes screening new residents for diabetes on admission and all residents at two yearly intervals; for all people with diabetes in care homes to have an individualised care plan tailored to their needs; and for all care home managers to put in place appropriate diabetes-specific training for all staff.
The charity also wants the Care Quality Commission (CQC) to make diabetes training part of any care home's registration requirements, and for every local commissioner of services to make an assessment of their local population's needs with regards to effective diabetes management in care homes.The report, 'Diabetes in care homes - Awareness, screening, training', is being launched today in Parliament (Monday 15 November 2010) to coincide with World Diabetes Day (Sunday 14 November).
Notes
1. 'Diabetes in care homes - Awareness, screening, training' . The report is based on Freedom of Information requests and a survey sent to care homes across England. To ensure a representative sample, 500 local authority commissioned and NHS-run homes were selected with an even geographical distribution. Since there are relatively few NHS-run homes, we weighted the sample proportionally towards local authority-commissioned homes. In addition, a representative sample of 500 private and voluntary run care homes were surveyed. These homes are not currently subject to the Freedom of Information Act 2000 and therefore this was a voluntary survey. Both surveys had the same core questions (with the only differential being an additional question to private and voluntary-run homes to determine their ownership).
2. Estimates for the UK are that the current residential and nursing care home population is 450,000 (Diabetes UK (2010). Good Clinical Practice Guidelines for Care Home Residents with Diabetes; 5). The prevalence of known diabetes reported across the survey population was 13 percent, (more than 1 in 8). However, only 23 per cent of homes screened all residents on admission for diabetes, and only 28 per cent on an annual basis. Those homes that did screen on admission had a higher known prevalence of diabetes of 15 per cent, where those that did not had a known prevalence of only 12 per cent. This figure indicates that there may be as many as 13,500 (3 per cent of 450,000) older people living in care homes whose diabetes has not been identified. An earlier study by Professor Alan Sinclair, Sinclair AJ, Gadsby R, Penfold S et al (2001). Prevalence of diabetes in care homes residents. Diabetes Care 24 (6); 1066-1068, found that the number of older people with diabetes in care homes increased to 26.7 per cent after screening. If this figure were applied to this report's findings the number of older people living in care homes in the UK whose diabetes has not been identified could be as high as 66,150.
3. Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). Insulin acts as a key unlocking the cells, so if there is not enough insulin, or it is not working properly, the cells are only partially unlocked (or not at all) and glucose builds up in the blood. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes, usually affects people over 40 (over 25 in people from South Asian and Black backgrounds) and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required. In most cases the condition is linked with being overweight and can go undetected for up to ten years meaning around 50 per cent of people show signs of complications by the time they are diagnosed. Type 1 diabetes develops when insulin-producing cells in the pancreas are destroyed. This type of diabetes usually appears before the age of 40 and is the least common of the two main types and accounts for around 10 per cent of all people with diabetes. Type 1 diabetes cannot be prevented, it is not known why it develops and it is not connected with being overweight. People with Type 1 diabetes have to take insulin either via a pump or by injections several times a day to stay alive.
4. Hypoglycaemia (or a 'hypo') occurs when the level of glucose in the blood falls too low. If left untreated the person having an hypo might, eventually, become unconscious. When a hypo happens the person often experiences 'warning signs', which occur as the body tries to raise the blood glucose level. These 'warning signs' vary from person to person but often include feeling shaky, sweating, tingling in the lips, going pale, heart pounding, confusion and irritability.
5. See here.
6. Diabetes UK is the leading charity for people with diabetes in the UK. We will spend ￡6 million on research in 2010 as well as campaign and provide information and support.
7. In the UK, there are currently 2.8 million people diagnosed with diabetes and it is estimated that a million people have Type 2 diabetes but do not know it.
8. The Diabetes UK Careline (0845 120 2960) offers information and support on any aspect of managing diabetes. The line is a low cost number and opens Monday to Friday between 9am and 5pm (and operates a translation service). Recorded information on a number of diabetes-related topics is also available on this number 24 hours a day. 9 Supporting our work as a 'Diabetes UK Supporting Member' entitles you to a range of benefits including our bi- monthly magazine Balance, reliable information booklets on diabetes, our confidential Diabetes UK Careline, over 400 local Diabetes UK support groups, and access to an exclusive personalised 'Supporting Members Area' on our website.
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