Type 1 diabetes in older adults: A researcher’s perspective

Managing blood glucose in older adults with type 1 diabetes can be particularly challenging. Hypoglycaemia continues to be a risk of insulin therapy, which in older people can lead to serious consequences such as falls, fractures, and hospital admissions. To counter this, relaxed glucose targets are often suggested, but relaxing glucose targets too much can be dangerous, as it may increase the risk of complications like diabetic ketoacidosis.

Given these complexities, there is a clear need for specific guidelines to support the safe and effective management of type 1 diabetes in older adults.

A research journey: ageing and type 1 diabetes

The research idea came from meeting older adults with type 1 diabetes throughout my career. I saw that the complexities of type 1 diabetes management through the challenges of ageing led to an increase in care needs compared to people without diabetes, or even those with type 2 diabetes. I saw this as unjust, but when exploring the available research on the topic, I found limited evidence, and what was there was largely guided by research into ageing with type 2 diabetes. This motivated me to explore the topic in further depth.

My research uses different methods to assess the experiences of living with type 1 diabetes as an older person. Continuous glucose monitors were used to assess glucose levels in older adults living with varying degrees of frailty. Interviews with older adults were then conducted to understand more about their experience.

The results are not yet published but highlight the resilience of this group and the impact of advancements in diabetes technology over the last 50 years. They also highlight concerns about future care options for people living with type 1 diabetes.

Type 1 diabetes and the need for care

People with type 1 diabetes often become experts in self-managing their diabetes, sometimes over several decades. Handing over diabetes management to a carer can be scary but is sometimes required, particularly where memory starts to be lost. Especially as insulin errors can be particularly dangerous.

With more people ageing with type 1 diabetes, it is likely that more will require such care. Services will need to adapt to meet the needs of people with type 1 diabetes who become unable to self-manage. This might involve bespoke education courses for carers, changes to the structure of district nurse provision, and greater awareness of type 1 diabetes within care homes.

Future directions

The report Facing the Future by Breakthrough T1D highlights a need for change in the provision of type 1 diabetes care in older adults. Further research could hold some of the answers, in particular there are opportunities to consider how automated insulin delivery, or hybrid closed loop therapy could be adapted to this setting to make insulin administration safe in a person who has lost the ability to self-manage. Overall, keeping the person living with type 1 diabetes at the centre of considerations is key to true meaningful change in this group.