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Sinclair A.J.,Institute of Diabetes for Older People IDOP
Diabetic Medicine | Year: 2011

A Task and Finish Group of Diabetes UK was convened over 14months to undertake a systematic review of the original 1999 British Diabetic Association guidance on care home diabetes, incorporate new research findings and produce a set of recommendations that are evidenced-based, practical and implementable within UK care home settings. The anticipation of Diabetes UK is that these guidelines will represent a national policy of good clinical practice for diabetes care within care homes. This executive summary demonstrates how the full guidelines should provide a framework of assessment of the quality of diabetes care within care homes, for use by regulatory bodies who have responsibility for this provision of diabetes care. This document is primarily based on recommendations for adults living within British care home environments and its focus, by virtue of the nature and characteristics of residents, is on older adults. Improvements in diabetes care within residential and nursing homes are likely to follow a sustained commitment by health and social care professionals to ensure that the well-being of residents with diabetes is paramount, that high-quality policies of diabetes care are implemented and monitored and effective diabetes education is a mandatory and integral part of care home staff training. © 2011 The Author. Diabetic Medicine © 2011 Diabetes UK. Source

Dunning T.,Deakin University | Dunning T.,International Diabetes Federation | Sinclair A.,University of Bedfordshire | Sinclair A.,Institute of Diabetes for Older People IDOP
Journal of Diabetes Nursing | Year: 2014

Managing older people with diabetes is complex due to multimorbidities, functional changes and polypharmacy, and there is little randomised control trial evidence to support recommendations. Significantly, there is a global lack of awareness about the effects of diabetes on ageing and vice versa. The International Diabetes Federation (IDF) Global Guideline for Managing Older People with Type 2 Diabetes seeks to address these issues. The guideline was launched by the IDF President, Sir Michael Hirst during a satellite symposium about diabetes in older people held in association with the World Diabetes Congress in Melbourne in December 2013. This article provides an overview of the IDF Guideline and suggests some ways DSNs and practice nurses can implement the guidelines in practice. Source

Sanz C.M.,Toulouse University Hospital Center | Sanz C.M.,French Institute of Health and Medical Research | Sanz C.M.,University Paul Sabatier | Hanaire H.,Toulouse University Hospital Center | And 8 more authors.
Diabetic Medicine | Year: 2012

Aims To determine whether diabetes mellitus influences functional status in patients with Alzheimer's disease. Methods We studied 608 community-dwelling patients with Alzheimer's disease from a prospective multicenter cohort. Diabetes was assessed at baseline. Functional status was assessed twice yearly with the Activities of Daily Living scale. Each patient had a baseline functional disability if their Activities of Daily Living score was <6. Progression of functional disability was defined by a decreased Activities of Daily Living score over 4years of follow-up visits. Results At baseline, diabetes was present in 63 participants (10.4%) and, compared with those without diabetes, was associated with functional impairment [age- and sex-adjusted OR=2.73 (95%CI 1.41-5.28)]. After controlling for confounders, the association remained significant [OR=2.04 (95%CI 1.02-4.11)]. Follow-up demonstrated a significant interaction between duration of Alzheimer's disease and diabetes, which was associated with progression of functional impairment in patients who had been diagnosed with Alzheimer's disease for less than 1year [age- and sex-adjusted hazard ratio=1.52 (95%CI 1.01-2.30), P=0.048], but not in those who had been diagnosed with Alzheimer's disease for more than 1year [age- and sex-adjusted hazard ratio=0.78 (95%CI 0.47-1.28), P=0.32]. Abnormal one-leg balance, polymedication and obesity seem to be important factors explaining the association between diabetes and functional status. Conclusions At baseline, the presence of diabetes significantly increases the risk of functional disability in patients with Alzheimer's disease; our longitudinal data confirm that in patients with a recent diagnosis of Alzheimer's disease (but not in those who have had Alzheimer's disease for longer than 1year), diabetes continues to worsen functional status. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK. Source

Mistry M.,Paradise Medical Center | Lister N.,Novartis | Andrews C.,Novartis | Geransar P.,Novartis | Sinclair A.,Institute of Diabetes for Older People IDOP
British Journal of Diabetes and Vascular Disease | Year: 2011

In the UK, type 2 diabetes mellitus in patients aged ≥ 65 years is a significant healthcare burden, compounded by an increasing elderly population. Intensive therapies to control blood glucose can be hazardous for this patient group and information is limited about well-tolerated therapies. This retrospective, real-world survey recorded glycated haemoglobin A1c (HbA1C) levels and incidences of hypoglycaemic events in 72 elderly and very elderly patients (65-74 years and ≥ 75 years, respectively) receiving the dipeptidyl peptidase-4 inhibitor vildagliptin as part of combination therapy. After vildagliptin initiation, mean HbA1C levels decreased from 8.2% to 7.4% (p=0.0415), the mean change in the elderly and very elderly subgroups being similar (-0.8%, -0.9%, respectively); the mean incidence of hypoglycaemic events (1.4%) was unchanged. This observational survey provides real-life evidence that in patients aged ≥ 65 years with type 2 diabetes, vildagliptin is an effective, well-tolerated add-on therapy with low hypoglycaemic risk. © 2011 SAGE Publications. Source

Atienzar P.,Albacete University Hospital | Abizanda P.,Albacete University Hospital | Guppy A.,University of Bedfordshire | Sinclair A.J.,Institute of Diabetes for Older People IDOP
British Journal of Diabetes and Vascular Disease | Year: 2012

Diabetes and frailty may be causally related and operate through each of the key components of the frailty phenotype or via the associated medical co-morbidities. The presence of frailty in a setting of diabetes increases the level of disability and leads to poorer clinical outcomes. The vascular complications of diabetes (both macro- and microvascular) are implicated in this aetiopathogenesis of frailty and any associated mood disturbance or cognitive impairments worsen the outcome. Research into exploring this relationship further is needed and this may lead to more effective interventional strategies. © 2012 The Author(s). Source

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