title: Managing diabetes in people with dementia: protocol for a realist review.
abstract: BACKGROUND
  Worldwide, the prevalences of diabetes and dementia are both increasing, particularly in older people. Rates of diabetes in people with dementia are between 13 and 20 %. Diabetes management and diabetic self-care may be adversely affected by the presence of dementia. There is a need to know what interventions work best in the management of diabetes in people living with dementia (PLWD) in different settings and at different stages of the dementia trajectory. The overall aim is to develop an explanatory account or programme theory about 'what works' in the management of diabetes in people in what context and to identify promising interventions that merit further evaluation.
  
  
  METHODS
  This study uses a realist approach including studies on the management of diabetes in older people, medication management, diabetes-related self-care, workforce issues and assessment and treatment. We will use an iterative, stakeholder driven, four-stage approach. Phase 1: development of initial programme theory/ies through a first scoping of the literature and consultation with key stakeholder groups (user/patient representatives, dementia-care providers, clinicians, diabetes and dementia researchers and diabetes specialists). Phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. Phase 4: actionable recommendations for the management of diabetes in PLWD.
  
  
  CONCLUSIONS
  A realist synthesis of the evidence will provide a theoretical framework (i.e. an explanation of how interventions work, for whom, in what context and why) for practice and future research work that articulates the barriers and facilitators to effective management of diabetes in people with dementia. By providing possible explanations for the way in which interventions are thought to work and how change is achieved, it will demonstrate how to tailor an intervention to the setting and patient group. The propositions arising from the review will also inform the design of future intervention studies.
  
  
  BACKGROUND
  PROSPERO registration number CRD42015020625.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, UK. f.bunn@herts.ac.uk.
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, UK. c.goodman@herts.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
authors.affiliation: School of Healthcare Sciences, Bangor University, Bangor, UK. j.rycroft-malone@bangor.ac.uk.
authors.forename: Jo Rycroft
authors.initials: JR
authors.lastname: Malone
authors.affiliation: School of Healthcare Sciences, Bangor University, Bangor, UK. p.jones@bangor.ac.uk.
authors.forename: Peter Reece
authors.initials: PR
authors.lastname: Jones
authors.affiliation: School of Healthcare Sciences, Bangor University, Bangor, UK. c.burton@bangor.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Burton
authors.affiliation: Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK. g.rait@ucl.ac.uk.
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, UK. d.trivedi@herts.ac.uk.
authors.forename: Daksha
authors.initials: D
authors.lastname: Trivedi
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK. Bayer@cardiff.ac.uk.
authors.forename: Antony
authors.initials: A
authors.lastname: Bayer
authors.affiliation: Foundation for Diabetes Research in Older People, London, UK. ajsinclair@diabetesfrail.org.
authors.forename: Alan
authors.initials: A
authors.lastname: Sinclair
mesh_terms: D003704:Dementia / Q000150:complications*; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D012107:Research Design; D000078202:Systematic Reviews as Topic