GPs and nurses anticipate compromised care over winter for elderly people with type 2 diabetes, according to new survey results

GPs and nurses anticipate compromised care over winter for elderly people with type 2 diabetes, according to new survey results

• COVID-19 is having a significant impact on care for people with long-term conditions across the board[i] and more needs to be done to support healthcare teams in managing patients
• New survey shows that more than half of all GPs and nurses feel the focus on COVID-19 has impacted on the care of the elderly and frail with type 2 diabetes[ii]
• 62% of GPs believe that both the diagnosis and ongoing treatment of these people is likely to be a reduced priority for the rest of 2020²
• People with type 2 diabetes already vulnerable to COVID-19 are more likely to develop a severe infection and have a poor prognosis[iii]

Bracknell, UK – Boehringer Ingelheim today announced new survey results revealing how the level of support offered to elderly and frail people with type 2 diabetes has been significantly compromised during the COVID-19 pandemic, with the ongoing consequences expected to be felt this winter.² Even before the pandemic, the NHS was already facing challenges around tackling type 2 diabetes[iv] and there was a need for special consideration on how to deliver care to this vulnerable group.[v] While the NHS has expanded its support to people with type 2 diabetes during this time,[vi] the new survey results have uncovered that challenges have only been exacerbated by the COVID-19 crisis,²  and there is a clear need to continue to provide further support to healthcare teams to manage these patients.

As part of the research, GPs and nurses in the UK were surveyed and collectively agree that there are inconsistencies in the care of type 2 diabetes in elderly and frail people, particularly when it comes to assessments, writing care plans and delivering care in different settings.² Key findings in the feedback from GPs and nurses include:

• Half [51%] agree that day-to-day management of type 2 diabetes in elderly and frail people is being better managed in the community than it is in care homes.²
• GPs and nurses have differing confidence levels when it comes to assessing the impact of age and frailty:
• Nurses are notably more confident, with 73% agreeing or strongly agreeing²
• Whereas GPs feel less confident, with only 43% of them agreeing or strongly agreeing²
• On average, GPs and nurses feel 25% of elderly and frail patients with type 2 diabetes are being over-treated with multiple medications to manage their blood sugar levels²
• Nearly two thirds [64%] highlight that care plans for elderly and frail type 2 diabetes patients are not being updated regularly enough and three quarters [75%] claim that they do not always have the time to commit to regularly updating them²
• More than two thirds [71%] of them claim to not have the right level detail to inform them²

Dr Nadeem Ashraf, Medical Lead for the Cardio-Renal-Metabolic Therapy Area said: “The survey results clearly show that 2020 has been a challenging year for healthcare professionals, highlighting the fact that the COVID-19 pandemic has added strain to already-stretched teams when it comes to managing elderly and frail people with type 2 diabetes. Care settings were under a lot of strain in the spring, making it even more important that, as we head into winter with the potential for more impact from COVID-19, healthcare professionals get more support to address any concerns in care and confidence in the care delivery to these vulnerable people.”

If type 2 diabetes is poorly managed, the consequences for elderly and frail patients are lasting, particularly as mismanagement of blood sugar levels, important in diabetes care, can lead to dangerously low blood sugar (hypoglycaemia). The survey results indicate that more support is needed for healthcare teams, especially those in care homes as both GPs and nurses cite concerns and low confidence at how hypoglycaemia is being spotted and managed in these settings.² A low blood sugar level can be dangerous if not treated quickly.[vii], and is also associated with an increased risk of falls, which carry significant burden.[viii] In 2015 alone, the total costs of falls to the NHS alone was estimated at £2.3 billion.[ix] Adding to this, the human cost of falling is not only the immediate acute injury, but often leads to distress, loss of confidence, loss of independence and increased vulnerability, and falls are the most common cause of injury-related deaths in people over the age of 75.[x]

Dr Ashraf continued: “Type 2 diabetes already puts huge amounts of pressure on the system, costing the NHS nearly £14 billion each year, of which only around £1 billion is attributed to the cost of medications and the remainder is due to managing complications. Even though this burden is becoming more visible, it’s clear that more needs to be done to support healthcare teams across all settings so that they are better able to individualise care decisions and protect these hugely vulnerable people.”[xi]

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About the research

Boehringer Ingelheim commissioned market research to evaluate the various challenges in managing type 2 diabetes in the elderly and frail. Its main objectives were to gain insight into the impact of their setting on the treatment of elderly and frail patients during these challenging times, investigate the impact of COVID-19 on managing type 2 diabetes in the elderly and frail, identify how healthcare professionals can be supported to help with the management of elderly type 2 diabetes patients the, and garner opinions regarding the different aspects of hypoglycaemic episodes and how to help optimise the management of these.

The research was conducted in partnership with medeConnect Healthcare Insight. The format was a 10-minute online quantitative survey conducted with: 100 GPs (who are members of Doctors.net.uk) and 60 Nurses. GPs were split into two sub-groups (depending on percentage of clinical time spent with patients in care homes): 70 GPs (≤10%), 30 GPs (>10%). Nurses were also split into two self-selecting sub-groups: 30 Practice Nurses and 30 Community Nurses. To qualify, respondents had to manage at least 20 type 2 diabetes patients in a typical month. Fieldwork for the study was conducted from 21 July to 28 August 2020.

About type 2 diabetes in the elderly

Type 2 diabetes is a common condition that causes the level of sugar (glucose) in the blood to become too high. It can cause symptoms like excessive thirst, needing to urinate a lot and fatigue. It's a lifelong condition that can affect everyday life.[xii] The numbers of people overall with the condition is set to grow to more than 5 million by 2025.[xiii] Around 90% of people with diabetes in the UK have type 2. It is a serious condition and if left untreated, high sugar levels in the blood can seriously damage parts of the body, including eyes, heart and feet. There are several factors that increase the risk of developing type 2 diabetes. They can include age, family history, ethnicity, high blood pressure, and being overweight.[xiv]

Most areas of care in diabetes are relevant to all age groups but there are some specific changes due to growing older which might affect your diabetes. In some cases, dietary advice for the older person with diabetes may differ from general recommendations. Older people in care homes are often more likely to be underweight than overweight and there is a high rate of undernutrition. It may not always be appropriate to reduce the fat, salt and sugar for every older person with diabetes. Poor or irregular eating can often be a cause of hypoglycaemia. This occurs at blood glucose levels of less than 4mmols/l. Older people may have added risk factors which can lead to hypoglycaemia:[xv]

• Insulin or certain diabetes medication
• Chronic kidney problems
• Poor food intake
• Having other illnesses or conditions

Many older people find their hypoglycaemia warning symptoms become less obvious, and some have no symptoms at all. Hypoglycaemia which goes unnoticed can cause very unpleasant symptoms, including confusion, speech and self-care difficulties, poor appetite, aggressive behaviour, unsteadiness and falls, losing consciousness, cognitive damage, heart attack or stroke.[xvi]

About type 2 diabetes and COVID-19

Type 2 diabetes can impact the risk of developing severe COVID-19 and lead to a poor prognosis. The reason for a worse prognosis is likely to be multifactorial and related to the combined impact of risk factors namely, advancing age, gender, ethnicity and co-morbidities such as hypertension, cardiovascular disease (CVD) and obesity.³ An older population is likely to be exposed to more than one of these risk factors, impacting on their outcomes. One in four people dying from COVID-19 in hospital also having type 2 diabetes[xvii]

About Boehringer Ingelheim and Cardio-Renal-Metabolic Conditions
Boehringer Ingelheim is driven to transform care for people with cardio-renal-metabolic conditions, which includes type 2 diabetes. Through our research and treatments, we aim to help more people protect the health of their organs, restore balance between the interconnected cardio-renal-metabolic systems and reduce their risk for serious complications. As part of our commitment to those whose health is jeopardised by cardio-renal-metabolic conditions, we will continue embracing a multidisciplinary approach towards care and focusing our resources on filling treatment gaps.

About Boehringer Ingelheim 
Since its founding in 1885, Boehringer Ingelheim is independent and family-owned. We have the freedom to pursue our long-term vision, looking ahead to identify the health challenges of the future and targeting those areas of need where we can do the most good.

As a world-leading, research-driven pharmaceutical company, more than 51,000 employees create value through innovation daily for our three business areas: Human Pharma, Animal Health, and Biopharmaceutical Contract Manufacturing. In 2019, Boehringer Ingelheim achieved net sales of 19 billion euros. Our significant investment of almost 3.5 billion euros in R&D drives innovation, enabling the next generation of medicines aiming to save lives and improve quality of life.

We realise more scientific opportunities by embracing the power of partnership and diversity of experts across the life-science community. By working together, we aim to accelerate the delivery of the next medical breakthrough to improve the lives of patients now, and in generations to come.

More information about Boehringer Ingelheim can be found at www.boehringer-ingelheim.co.uk.

 Contacts

Andrew Nye
Head of Therapy Area Communications
Boehringer Ingelheim 
Email: andrew.nye@boehringer-ingelheim.com

Phone: +44 7768 023350