HbA1c and Frailty: Finding the sweet spot

Introduction:

Frail older adults with diabetes are particularly vulnerable to harm from tight glycaemic control. Hypoglycaemia can increase the risk of falls, delirium and prolong hospital stay especially in those with frailty. Regional and National guidelines (NICE NG28, JBDS) recommend individualised HbA1c targets based on frailty status, yet in routine inpatient practice this is often overlooked. The aim of this quality improvement project (QIP) was to improve frailty scoring and individualised HbA1c targets in frail diabetic inpatients

Method:

This quality improvement project was conducted on a general medical ward within a large tertiary care hospital. A baseline audit (n=22) revealed that only 50% of frail diabetic inpatients had a recorded Clinical Frailty Score (CFS), and none had documented HbA1c targets. Interventions included teaching, educational posters, and verbal reminders to the clinical team. Outcome measures included rates of CFS documentation, HbA1c testing, HbA1c target documentation, and hypoglycaemic events. Differences in pre- and post- intervention were analysed using Chi-squared test for categorical data.

Results:

CFS documentation improved from 50% to 91% (p = 0.021), while HbA1c target documentation improved from 0% to 64% (p < 0.001). HbA1c testing increased from 41% to 64%. Hypoglycaemic events reduced from 50% to 36%, a clinically relevant finding though not statistically significant. The post-intervention group size was 11. Mean patient age was ~79 years in both groups.

Conclusions:

This project demonstrated that simple, low-resource interventions can significantly improve frailty assessment and individualised HbA1c documentation. These changes align with national guidance, enhance patient safety, and support personalised care. Further work should focus on sustainability and integration into electronic documentation systems.