DiaCare
Person-Centred Diabetes Care for Older People in Community Care

Insulin-treated diabetes in community care

More people with diabetes are living longer, and insulin treatment is becoming increasingly common among older adults in nursing homes and supported home care. This also includes people with type 1 diabetes, who today are more likely to reach older age than in the past. In Linköping Municipality, approximately 10% of residents in nursing homes have insulin-treated diabetes. At the same time, community care often works with limited resources, and much of the daily insulin treatment is provided by nurse assistants with limited medical training. This means that staff with the least medical training may be the first to notice changes in a person’s condition and initiate medical assessment, which can create major patient safety risks. If changes in blood glucose are not detected or managed in time, the consequences can be serious and, in the worst cases, fatal. More knowledge is therefore needed about how diabetes care works in community care today, and what support is required to make care safer.

The DiaCare study

DiaCare aims to develop and evaluate a more person-centred diabetes care for older people receiving insulin treatment in community care. In the study, we want to understand how diabetes care works today, what challenges exist in daily practice, and what support is needed to improve safety and security for both patients and staff.

 

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Together with Linköping Municipality and national and international collaborators, we aim to develop a new care model in close collaboration with patients, relatives, and healthcare staff. This model will then be tested in a large, pragmatic cluster-randomised study in several Swedish regions. The goal is to improve blood glucose control, reduce acute complications, strengthen quality of life, and create a safer care pathway between community care, primary care, and hospital care. 

 

DiaCare is planned to be carried out in five steps:

1. Mapping current care
   First, we want to examine how insulin treatment in community care for older people works today. The aim is to gain an overall understanding of current practices, challenges, and needs, which can then form the basis for developing a new and safer care model. This mapping is carried out through a systematic review of previous research, a national survey sent to all municipalities in Sweden, and interviews with patients, relatives, and healthcare staff.
   
   
2. Co-creation of intervention
   Based on the mapping, we will develop a new care model together with patients, relatives, and healthcare staff. The aim is to ensure that the model responds to current needs and contributes to safer and more secure insulin treatment.
   
   
3. Pilot study in Linköping
   The new care model will first be tested on a smaller scale in Linköping Municipality. The pilot study will help us understand how the model works in practice and whether any adjustments are needed before it is tested on a larger scale.
   
   
4. National cluster-randomised intervention study
   The care model will then be tested in a larger study across several Swedish regions. The study aims to examine whether the intervention can improve blood glucose control, reduce acute complications, strengthen quality of life, and make the healthcare system safer.
   
   
5. Implementation
   a. If the care model shows positive effects, we will study how it can be introduced and used long-term in community care. The focus is on creating a model that is sustainable, practical to use, and adapted to community care.

 

For researchers:, PROSPERO systematic review protocol:
PROSPERO systematic review protocol