Symptom burden greatest in undiagnosed diabetes

Davies TT, Graue M, Igland J et al (2019) Diabetes prevalence among older people receiving care at home: associations with symptoms, health status and psychological well-being. Diabet Med 36: 96–104

• Information about the prevalence of diabetes in older people receiving care at home is limited, and so the authors of this study set out to determine the prevalence of this condition and explore whether diabetes (HbA_1c ≥48 mmol/mol; ≥6.5%) and/or self-reported diabetes were associated with differences in health status, symptoms and psychological wellbeing.  
• People aged 65 or over who were receiving care at home in Western Norway were invited to complete a survey consisting of the Mini Mental State Examination-NR questionnaire to assess cognitive status, the Symptom Check-List, two items from the WHOQOL-BREF to measure quality of life, the EuroQuol EQ-5D-5L to measure health status, and the WHO-Five Well-Being Index to measure psychological wellbeing. 
• A total of 377 people with a median age of 86 participated in the study, 34% of which were men.
• Participants’ HbA_1c levels were measured and they were asked whether they had, or had ever had, diabetes. They were then separated into four groups: no diabetes; self-report only; HbA_1c ≥48 mmol/mol (≥6.5%) plus self-reported diabetes; and HbA_1c ≥48 mmol/mol (≥6.5%) only.
• Ninety-two participants (24%) were found to have diabetes, with the prevalence being significantly higher in men than in women (34% versus 20%). Within this group, 14% were unaware that they had an elevated HbA_1c.
• Self-reported symptoms of diabetes differed significantly between the groups with diabetes, with the groups that had elevated HbA_1c reporting more symptoms. The poorest quality of life, wellbeing and health status was found in those with undiagnosed diabetes.
• Increased effort should be made to identify individuals receiving care at home who have undiagnosed diabetes in order to improve their care and reduce their symptoms.

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