Endocrine Abstracts

The proportion of older adults and the prevalence of diabetes are increasing globally. As functional and cognitive capacities decline with age, diabetes management becomes increasingly challenging particularly for those requiring insulin. This study aimed to identify factors associated with an increased hospital length of stay (LOS) in older adults with diabetes. A retrospective review of all patients with diabetes aged ≥75 years on insulin at time of admission to hospital during a 1-year period (July 2023-2024) was carried out. 117 patients (26% Type 1/lADA/Pancreatic diabetes and 74% Type 2) were included. On admission, older people on insulin had poor diabetes control, with a mean HbA1c of 71 mmol/mol. The average LOS was 19 days. There was a high prevalence of cognitive (16%) and functional (47%) impairment among older people on insulin and 53% of admissions were primarily diabetes related. Those with functional or cognitive impairment had a longer length of stay than those who did not (23 days vs 12 days, P = 0.002). Only 26% of individuals with a documented functional or cognitive impairment self-managed their insulin; 47% relied on community supports (either a public health nurse or family members) and 27% lived in a residential care home. 62% of admissions in this cohort were diabetes related. By comparison, for those without cognitive or functional impairment, 98% self-managed their insulin, and 37% of admissions in this cohort were diabetes related. Cognitive and functional impairment are prevalent in older adults with diabetes on insulin admitted to hospital; they are associated with a significantly longer hospital length of stay and frequently require community supports for insulin administration. This study emphasises the importance of individualised multi-disciplinary management strategies and enhanced community engagement in these cases.