Abstract
Introduction:
Older adults with frailty are particularly vulnerable to harm from tight glycaemic control, with hypoglycaemia contributing to falls, cognitive decline, and increased mortality. National (JBDS: Inpatient Care of the Frail Older Adult with Diabetes) and local (Buckinghamshire, Oxfordshire & Berkshire–BOB) guidelines recommend individualising glucose targets according to frailty level, but adherence is inconsistent. This quality improvement project evaluated glycaemic management in inpatients with frailty, aiming to reduce hypoglycaemia and improve target setting in line with frailty status.
Method:
A two-cycle quality improvement project was undertaken in elderly care wards at Royal Berkshire Hospitals. Cycle 1 (Jan–Mar 2025) included 31 patients with diabetes & frailty; Cycle 2 (May–Jul 2025) included 12 patients following staff education and guideline reinforcement. Frailty was assessed using the Clinical Frailty Scale (CFS), with glucose targets set accordingly. Data from Diabetes Specialist Nurse referrals and incident reports were analysed for hypoglycaemia rates, target documentation, and medication adjustments in both PDSA cycles.
Results:
Between cycles, patients experiencing hypoglycaemia fell by 61% (31 to 12), with frequent episodes reduced by 67% and severe episodes (≤3 mmol/L) by 61%. Among patients with CFS 7–9, correct target documentation improved from 25% to 80%. In contrast, target setting decreased from 56% to 20% in patients with CFS 4-6, indicating variability in the practice. Proactive medication optimisation, including insulin de-escalation and adjustment of oral hypoglycaemic agents (OHAs), was applied more consistently in Cycle 2.
Conclusion:
Frailty-adjusted glycaemic targets and proactive medication review can markedly reduce hypoglycaemia in older adults with frailty during their admission. Sustaining improvements will require ongoing staff education, standardised pathways, and clear documentation to ensure safer diabetes management in this vulnerable population.
Comments
Well-documented QI methodology
Not only the project is high impact , the use of Q.I methodology has illustrated eloquently as well.
Outstanding visual poster
This poster has excellent documentation, particularly with the visual aids of the PDSA cycle being very clear.