Anne Kilvert

The crisis in diabetes care in England

Failings identified by recent reports must be tackled urgently

Intensive education for lifestyle change in diabetes

Ongoing input is required to effect and maintain change in behaviour In the past 10 years the diabetes control and complications trial and the UK prospective diabetes study (UKPDS) have shown that tight control of diabetes reduces the risk of complications in type 1 and type 2 diabetes.1 2 As a result of these studies we have set our patients demanding targets, which often require important changes in their lifestyle. But we have failed to provide the education and self management training needed to help them meet these targets. In this context, intensive modifications to lifestyle means structured education designed to facilitate change in behaviour. Such education programmes are used in type 1 and type 2 diabetes and in prevention of diabetes in people with impaired glucose tolerance. Traditional education for diabetes treats the patient as a receptacle for knowledge or a pot to be filled with information by doctors, nurses, and dieticians. To achieve change in behaviour education must encourage self motivation and self determination,3 and a professional who simply tells …

Diabetes care for the most vulnerable in society – the views of professionals working in care homes and domiciliary care using focus group methodology

Using focus group methods, we report that the main concerns of health care professionals working in care homes and in the domiciliary sector are as follows: Poor communication with all other health care agencies, including hospital, primary care and mental servicesThe need for training, specifically in diabetes and dementiaCurrently available e-learning was not found to be usefulPoor support from the specialist diabetes team

The challenges of type 1 diabetes in older people

Over 200 000 people in England and Wales have type 1 diabetes. After the discovery of insulin, it became clear that people with diabetes had a reduced life expectancy and in the 1950s someone with type 1 diabetes might only expect to live until their sixth decade before they died from diabetic complications. Since then, longevity has increased and significant numbers are living into their eighth decade.

Palliative care and heart failure in diabetes

Heart failure is a major cause of morbidity and mortality in diabetes and once established the mortality is very high. There is evidence for a U‐shaped association between HbA1c and risk of mortality with the lowest risk associated with an HbA1c of 6.5–7.5% (48–58 mmol/mol). Guidelines for management of chronic heart failure recommend palliative care for end‐stage disease, but because of the unpredictable trajectory of heart failure it can be difficult to decide exactly when palliative care should be introduced. Despite the frequent combination of diabetes and heart failure, end of life guidelines for each condition fail to provide recommendations for management when they coexist.

Diagnosis and management of diabetes in older people

The incidence of diabetes has plateaued since 2004, although the prevalence continues to rise. The highest incidence is in people over the age of 70 years, most of whom have type 2 diabetes; a minority have type 1, which can present at any age. Type 1 diabetes may present more slowly in older people, a condition sometimes known as latent autoimmune diabetes in adults (LADA).