title: A community-based study of diabetes-related skills and knowledge in elderly people with insulin-requiring diabetes.
abstract: An open cross-sectional study of elderly (age greater than 65 yr) patients with insulin-requiring diabetes mellitus (n = 57) was undertaken to audit safety of self-management. Levels of knowledge and management skills of hypoglycaemia, hyperglycaemia, and foot care were determined. The prevalence of hypoglycaemia, visual impairment, and at-risk feet and the ability to perform practical procedures (insulin injection and self-monitoring) were assessed. Drawing up insulin and self-injection was correct in 84% and 76% of patients, but 53% of self-monitored urine or blood tests were performed incorrectly. Twenty-six per cent experienced hypoglycaemia at least monthly and 25% had been seen at the hospital with hypoglycaemia in the last year. Eighteen per cent did not know what action to take with hypoglycaemia. Forty-six per cent did not know any hyperglycaemic symptoms or signs. Prompted with symptoms, 35% still did not know what to do and 21% would take inappropriate action when self-monitored tests read high. Fifty-one per cent had impaired vision, 61% peripheral neuropathy and 24% peripheral vascular disease, with the result that 78% had at-risk feet. Fifteen percent inspected or washed their feet infrequently, 40% walked barefoot occasionally, and 47% would take potentially dangerous action in the event of foot injury. This study demonstrates serious deficiencies in the basic education and management skills in our elderly insulin-requiring diabetic population that could result in morbidity and mortality. Greater effort and vigilance by health care professionals must be directed towards this group.
authors.affiliation: Department of Endocrinology, Charing Cross Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Pegg
authors.forename: F
authors.initials: F
authors.lastname: Fitzgerald
authors.forename: D
authors.initials: D
authors.lastname: Wise
authors.forename: B M
authors.initials: BM
authors.lastname: Singh
authors.forename: P H
authors.initials: PH
authors.lastname: Wise
mesh_terms: D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D005528:Foot; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology; D007003:Hypoglycemia / Q000503:physiopathology; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D010353:Patient Education as Topic; D012648:Self Care
chemical_list: D007328:Insulin