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Derived glucose variations when preventing therapeutic inertia in potentially over-treated older people with diabetes

Why the research is needed

In diabetes care, the priority is often to manage high blood sugar levels and prescribe blood sugar-lowering therapies to prevent progressive, long-term complications associated with diabetes. However, some people with diabetes can be over-treated and for older people who are frail, this puts them at high risk of low blood sugar levels which could lead to more falls, fractures, hospitalisations, and deaths. Guidelines are now in place detailing when to stop, change or reduce some diabetes medication in this population but the precise blood sugar levels that are associated with low and high blood sugar events in older people is unknown.

What is already known about the subject

In England, there have been significant increases in hospital admissions as a result of low blood sugar, and hospitalisation for low blood sugar events is associated with cardiovascular problems, cognitive impairment, falls and fractures, death, reduced quality of life, and a poor prognosis. Severe low blood sugar levels continue to be problematic for older people with type 2 diabetes and as such it is difficult to know whether the benefits of treatment with blood sugar-lowering therapies outweigh the adverse effects. Continuous blood sugar monitoring is an intervention that is often used in the management of diabetes, and its use has become more prevailing since the COVID-19 pandemic. Currently, there are no studies that objectively measure the detailed blood sugar levels when adjusting medication/s.

Who we will be working with

We will be working with older people (≥65 years old) with diabetes (and their carers) who are either living in a care home or are housebound.

How patients and the public are involved

We will communicate with patients and the public to design and refine the study documents, including diaries, logbooks, and device instructions. We will also discuss how best to present and summarise the findings.

What we will do

Participants will be recruited and asked to wear a continuous blood sugar monitor for 12 weeks and complete a diary indicating low and high blood sugar events/episodes. Healthcare professionals will use this information from the glucose monitor and the participants’ health diary, along with a scripted algorithm, to review participants medication every 4 weeks and adjust their medication accordingly. Data at the start and the end of the study will be compared.

What the benefits will be

The immediate benefits will be for the patient themselves. There will be a reduction in low blood sugar events in the study population and their health should improve by increasing the time people are in safe blood sugar range while altering their medication. There may potentially be a reduction in hospital admissions and ambulance call outs for abnormal (very high or very low) blood sugar levels. The results of this study may inform ways to prevent older people with diabetes being admitted to hospital in the future and additionally, we hope there will better patient satisfaction from stopping finger pricking and reduced low blood sugar events/episodes.

When the findings will be available

The research will conclude in May 2023.

How we are planning for implementation

We are planning to use the research findings to update patient support and treatment strategies (de-intensification of medications) where possible. This may include updating guidelines or management strategies for older, frail people living with diabetes. Our research team includes members who have important roles in guiding these types of strategies, so we will be able to make sure that any positive results from the study have a constructive impact in primary care and are implemented in real-world practice.