Diabetes prevalence among older people receiving care at home: associations with symptoms, health status and psychological well-being

Abstract

Aims: To determine the prevalence of diabetes among older people receiving care at home, and to explore differences in sociodemographic and clinical characteristics, symptoms, health status, quality of life and psychological well‐being between diabetes categories defined as HbA1c ≥ 48 mmol/mol (6.5%) and/or self‐report. Methods: A community‐based sample of 377 people receiving care at home in Western Norway participated in a cross‐sectional survey. Instruments included the MMSE‐NR, Symptom Check‐List, WHO Quality of Life‐BREF (WHOQOL‐BREF, global items), EuroQol EQ‐5D‐5L/EQ‐5D‐VAS and WHO‐Five Well‐Being Index (WHO‐5). Participants were grouped into four categories: no diabetes, self‐report only, HbA1c ≥ 48 mmol/mol (6.5%) and self‐report, and HbA1c ≥ 48 mmol/mol (6.5%) only. Results: Median age (IQR) was 86 (81–91) years and 34% of the sample were men. We identified 92 people (24%) with diabetes. Diabetes was more prevalent in men than women (34% vs. 20%, age‐adjusted P = 0.005). Among people with diabetes, 14% were unaware of their diagnosis. There were significant differences in symptoms between the diabetes categories, with more symptoms (abnormal thirst, polyuria, genital itching, nausea, excessive hunger, perspiring, cold hands/feet, daytime sleepiness) among the groups with elevated HbA1c. Significant differences in WHO‐5, WHOQOL‐BREF and EQ‐5D‐5L between diabetes categories were identified, with the poorest scores in the group with undiagnosed diabetes. Conclusions: A high percentage of people with diabetes receiving care at home are unaware of their diagnosis. Diabetes deserves increased case‐finding efforts and allocation of resources towards those receiving care at home to alleviate symptoms and the burden of inadequate diabetes care.