Issues and methodological challenges in developing and evaluating health care interventions for older people with diabetes mellitus - part 2

A pilot project to explore the feasibility and potential of a protocol to support district nurses in the assessment of older frail people with type 2 diabetes

A study was undertaken to explore the potential of district nurses assessing older frail people with type 2 diabetes using an explicit schedule in the form of an annual review. A pilot study following pre- and post-test (six-month interval) design explored both process and outcome variables. Twelve older people (mean age 79 years, range 70-86 years) with a diagnosis of type 2 diabetes took part.

No statistically significant differences were observed on any of the main outcome measures at the post-test assessment. These findings were explained by insufficient sample size and attrition; a failure to instigate treatment following the identification of specific diabetes-related problems, especially on the part of the GP; and the fact that the sample was reasonably well controlled at the start of the study.

The study showed that district nurses were able to administer the annual review satisfactorily but that they found execution of the protocol time-consuming. A great deal of variation was found among respondents, which pointed to different sub-groups of frailty in the older population of people with diabetes, each sub-group having different needs.

It was concluded that if district nurses are going to undertake this work, their activity needs to be targeted at the groups of older people most likely to benefit. The current protocol needs further refinement and should be linked to clearer clinical action pathways with a multidisciplinary focus to ensure that the appropriate remedial therapy is instigated.