title: Self management and patient understanding of diabetes in the older person.
abstract: OBJECTIVE
  To examine knowledge and management of diabetes by older people.
  
  
  METHODS
  A representative sample of 1047 people with Type 2 diabetes, aged 75 years and over, were asked a series of questions relating to their diabetes management and their understanding of self management. The impact of cognitive impairment and socio-economic status were assessed.
  
  
  RESULTS
  The majority of people, 1015 (96.9%), were under the care of a health professional and 1018 (97.2%) were taking insulin, tablets, controlling their diet or a combination. Cognitive impairment (Mini-Mental State Examination ≤ 23) was found in 235 (22.5%) people. Recent eye, foot and dietician assessment was reported by 813 (77.7%), 836 (79.7%) and 326 (31.1%) people, respectively. A quarter overall and 70% of those taking insulin tested their blood glucose. In the insulin group, 78 (54.2%) reported hypoglycaemia and those with cognitive impairment gave more incorrect responses when asked about diabetes management. Socio-economic status made very little difference to any of these outcomes.
  
  
  CONCLUSIONS
  Most older people with diabetes, regardless of their socio-economic status, are under the care of a healthcare professional and use medication or diet to manage their disease. Large numbers also attend foot and eye examinations. However, over one fifth of older people with diabetes have cognitive impairment. Older people had a reasonable understanding of their diabetes management but this was worse in those people with cognitive impairment.
authors.affiliation: London School of Hygiene and Tropical Medicine and Portsmouth Hospitals Trust, Queen Alexandra Hospital, Portsmouth, UK. hewitt@porthosp.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Hewitt
authors.forename: L
authors.initials: L
authors.lastname: Smeeth
authors.forename: N
authors.initials: N
authors.lastname: Chaturvedi
authors.forename: C J
authors.initials: CJ
authors.lastname: Bulpitt
authors.forename: A E
authors.initials: AE
authors.lastname: Fletcher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000188:drug therapy / Q000523:psychology*; D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D010353:Patient Education as Topic; D010817:Physician-Patient Relations / Q000941:ethics; D012648:Self Care / Q000941:ethics / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D007328:Insulin