Managing diabetes in people with dementia: protocol for a realist review

Journal article


Bunn, F., Goodman, C., Rycroft Malone, J., Reece Jones, P., Burton, C., Rait, G., Trivedi, D., Bayer, A. and Sinclair, A. 2016. Managing diabetes in people with dementia: protocol for a realist review. Systematic Reviews. 5 (5).
AuthorsBunn, F., Goodman, C., Rycroft Malone, J., Reece Jones, P., Burton, C., Rait, G., Trivedi, D., Bayer, A. and Sinclair, A.
Abstract

Background
Worldwide, the prevalences of diabetes and dementia are both increasing, particularly in older people. Rates of diabetes in people with dementia are between 13 and 20 %. Diabetes management and diabetic self-care may be adversely affected by the presence of dementia. There is a need to know what interventions work best in the management of diabetes in people living with dementia (PLWD) in different settings and at different stages of the dementia trajectory. The overall aim is to develop an explanatory account or programme theory about ‘what works’ in the management of diabetes in people in what context and to identify promising interventions that merit further evaluation.

Methods/design
This study uses a realist approach including studies on the management of diabetes in older people, medication management, diabetes-related self-care, workforce issues and assessment and treatment. We will use an iterative, stakeholder driven, four-stage approach. Phase 1: development of initial programme theory/ies through a first scoping of the literature and consultation with key stakeholder groups (user/patient representatives, dementia-care providers, clinicians, diabetes and dementia researchers and diabetes specialists). Phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. Phase 4: actionable recommendations for the management of diabetes in PLWD.

Discussion
A realist synthesis of the evidence will provide a theoretical framework (i.e. an explanation of how interventions work, for whom, in what context and why) for practice and future research work that articulates the barriers and facilitators to effective management of diabetes in people with dementia. By providing possible explanations for the way in which interventions are thought to work and how change is achieved, it will demonstrate how to tailor an intervention to the setting and patient group. The propositions arising from the review will also inform the design of future intervention studies.

KeywordsDiabetes; Dementia
Year2016
JournalSystematic Reviews
Journal citation5 (5)
PublisherBioMed Central
ISSN2046-4053
Digital Object Identifier (DOI)doi:10.1186/s13643-015-0182-4
Official URLhttp://doi.org/10.1186/s13643-015-0182-4
Publication dates
Online07 Jan 2016
Publication process dates
Accepted23 Dec 2015
Deposited22 May 2020
References

1. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of
dementia in diabetes mellitus: a systematic review. Lancet Neurol.
2006;5(1):64–74.
2. Bruce DG, Casey GP, Grange V, Clarnette RC, Almeida OP, Foster JK, et al.
Cognitive impairment, physical disability and depressive symptoms in older
diabetic patients: the Fremantle Cognition in Diabetes Study. Diabetes Res
Clin Pract. 2003;61(1):59–67.
3. Feil DG, Zhu CW, Sultzer DL. The relationship between cognitive
impairment and diabetes self-management in a population-based
community sample of older adults with type 2 diabetes. J Behav Med.
2011;35(2):190–9.
4. Prince M, Jackson J. World Alzheimer report 2009. London: Alzheimer’s
Disease International. Available: http://www.alz.co.uk/research/files/
WorldAlzheimerReport.pdf. Accessed 18 September 2012. Alzheimer’s
Disease International 2009.
5. Centers for Disease Control and Prevention. National diabetes fact sheet:
general information and national estimates on diabetes in the United
States. Atlanta, Georgia: U.S. Department of Health and Human Service,
Centers for Disease Control and Prevention; 2011.
6. Fagot-Campagna A, Bourdel-Marchasson I, Simon D. Burden of diabetes in
an aging population: prevalence, incidence, mortality, characteristics and
quality of care. Diabete Metab. 2005;31:5S35–52.
7. Aspray TJ, Nesbit K, Cassidy TP, Farrow E, Hawthorne G. Diabetes in British
nursing and residential homes: a pragmatic screening study. Diabetes Care.
2006;29(3):707–8.
8. Zhang X, Decker FH, Luo H, Geiss LS, Pearson WS, Saaddine JB, et al. Trends
in the prevalence and comorbidities of diabetes mellitus in nursing home
residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58(4):724–30.
doi:10.1111/j.1532-5415.2010.02786.x.
9. Sinclair AJ, Gadsby R, Penfold S, Croxson SC, Bayer AJ. Prevalence of
diabetes in care home residents. Diabetes Care. 2001;24(6):1066–8.
10. Boyle JP, Honeycutt AA, Narayan KV, Hoerger TJ, Geiss LS, Chen H, et al.
Projection of diabetes burden through 2050 impact of changing
demography and disease prevalence in the US. Diabetes Care.
2001;24(11):1936–40.
11. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of
the year 2050 burden of diabetes in the US adult population: dynamic
modeling of incidence, mortality, and prediabetes prevalence. Popul Health
Metrics. 2010;8:29. doi:10.1186/1478-7954-8-29.
12. Strachan MW, Deary IJ, Ewing FM, Frier BM. Is type II diabetes associated
with an increased risk of cognitive dysfunction? A critical review of
published studies. Diabetes Care. 1997;20(3):438–45.
13. Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia
and mild cognitive impairment: a meta-analysis of longitudinal studies.
Intern Med J. 2012;42(5):484–91. doi:10.1111/j.1445-5994.2012.02758.x.
14. Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, et al.
Comorbidity and dementia: a scoping review of the literature. BMC Med.
2014;12(1):192. doi:10.1186/preaccept-1961031831372106.
15. Feil DG, Pearman A, Victor T, Harwood D, Weinreb J, Kahle K, et al. The role
of cognitive impairment and caregiver support in diabetes management of
older outpatients. Int J Psychiatry Med. 2009;39(2):199–214.
Bunn et al. Systematic Reviews (2016) 5:5 Page 6 of 8
16. Hewitt J, Smeeth L, Chaturvedi N, Bulpitt CJ, Fletcher AE. Self management
and patient understanding of diabetes in the older person. Diabet Med.
2010;28(1):117–22.
17. Sinclair AJ, Girling AJ, Bayer AJ. Cognitive dysfunction in older subjects with
diabetes mellitus: impact on diabetes self-management and use of care
services. Diabetes Res Clin Pract. 2000;50(3):203–12.
18. Abdelhafiz AH, Sinclair AJ. Hypoglycaemia in residential care homes. Br J
Gen Pract. 2009;59(558):49–50. doi:10.3399/bjgp09X394860.
19. Bloomfield HE, Greer N, Newman D, MacDonald R, Carlyle M, Fitzgerald P,
et al. Predictors and consequences of severe hypoglycemia in adults with
diabetes—a systematic review of the evidence. 2012.
20. Bruce D, Davis W, Casey G, Clarnette R, Brown S, Jacobs I, et al. Severe
hypoglycaemia and cognitive impairment in older patients with diabetes:
the Fremantle Diabetes Study. Diabetologia. 2009;52(9):1808–15.
21. Feil DG, Rajan M, Soroka O, Tseng C-L, Miller DR, Pogach LM. Risk of
hypoglycemia in older veterans with dementia and cognitive
impairment: implications for practice and policy. J Am Geriatr Soc. 2011;
59(12):2263–72.
22. Kirkman SM, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes
in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56.
doi:10.1111/jgs.12035.
23. Connolly A, Iliffe S, Gaehl E, Campbell S, Drake R, Morris J, et al. Quality of
care provided to people with dementia: utilisation and quality of the annual
dementia review in general practice. Br J Gen Pract. 2012;62(595):e91–8. doi:
10.3399/bjgp12X625148.
24. Thorpe CT, Thorpe JM, Kind AJH, Bartels CM, Everett CM, Smith MA. Receipt
of monitoring of diabetes mellitus in older adults with comorbid dementia.
J Am Geriatr Soc. 2012;60(4):644–51.
25. Vitry AI, Roughead EE, Preiss AK, Ryan P, Ramsay EN, Gilbert AL, et al.
Influence of comorbidities on therapeutic progression of diabetes treatment
in Australian veterans: a cohort study. PLoS One. 2010;5(11):e14024. doi:10.
1371/journal.pone.0014024.
26. Zhang Y, Vitry A, Roughead E, Ryan P, Gilbert A. Co-morbidity and the
utilization of health care for Australian veterans with diabetes. Diabet Med.
2010;27(1):65–71. doi:10.1111/j.1464-5491.2009.02872.x.
27. Sinclair AJ, Hillson R, Bayer AJ, National Expert Working Group. Diabetes
and dementia in older people: a best clinical practice statement by a
multidisciplinary National Expert Working Group. Diabet Med.
2014;31(9):1024–31. doi:10.1111/dme.12467.
28. NICE. Diabetes overview NICE pathways http://pathways.nice.org.uk/
pathways/diabetes: National Institute for Health and Care Excellence2014.
Accessed date 29 December 2015.
29. Inzucchi S, Bergenstal R, Buse J, Diamant M, Ferrannini E, Nauck M, et al.
Management of hyperglycaemia in type 2 diabetes: a patient-centered
approach. Position statement of the American Diabetes Association (ADA)
and the European Association for the Study of Diabetes (EASD).
Diabetologia. 2012;55(6):1577–96.
30. Sinclair AJ, Paolisso G, Castro M, Bourdel-Marchasson I, Gadsby R, Rodriguez
Manas L. European Diabetes Working Party for Older People 2011 clinical
guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab.
2011;37 Suppl 3:S27–38. doi:10.1016/s1262-3636(11)70962-4.
31. International Diabetes Federation. Managing older people with type 2
diabetes global guideline http://www.idf.org/guidelines-older-people-type2-diabetes. Accessed date 29 December 2015.
32. Morley JE, Sinclair A. Individualising treatment for older people with
diabetes. Lancet. 2013;382(9890):378–80.
33. Sinclair A, Morley J. Frailty and diabetes. Lancet. 2013;382(9902):1386–7.
34. Strain WD, Lukashevich V, Kothny W, Hoellinger MJ, Paldanius PM.
Individualised treatment targets for elderly patients with type 2 diabetes
using vildagliptin add-on or lone therapy (INTERVAL): a 24 week,
randomised, double-blind, placebo-controlled study. Lancet. 2013;
382(9890):409–16. doi:10.1016/s0140-6736(13)60995-2.
35. Jones A, Gladstone BP, Lubeck M, Lindekilde N, Upton D, Vach W.
Motivational interventions in the management of HbA1c levels: a
systematic review and meta-analysis. Prim Care Diabetes. 2014;8(2):91–100.
doi:10.1016/j.pcd.2014.01.009.
36. Duke Sally-Anne S, Colagiuri S, Colagiuri R. Individual patient education for
people with type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2009
doi:10.1002/14651858.CD005268.pub2.
37. Pal K, Eastwood Sophie V, Michie S, Farmer Andrew J, Barnard Maria L,
Peacock R et al. Computer-based diabetes self-management interventions
for adults with type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2013
doi:10.1002/14651858.CD008776.pub2.
38. Corben S, Rosen R. Self-management for long-term conditions: patients’
perspectives on the way ahead. Kings Fund, 2005.
39. Bunn F, Goodman C, BRAYNE C, Norton S, Rait G, Robinson L et al. Comorbidity
and dementia: improving healthcare for people with dementia. (CoDem)
http://www.nets.nihr.ac.uk/projects/hsdr/11101707: NIHR, HS & DR; 2012.
Accessed date 29 December 2015
40. NICE. End of life care for people with dementia. Commissioning guide:
National Institute for Health and Clinical Excellence 2010.
41. Pawson R. Evidence-based policy: a realist perspective. London: Sage; 2006.
42. Hardwick R, Pearson M, Byng R, Anderson R. The effectiveness and
cost-effectiveness of shared care: protocol for a realist review. Syst Reviews.
2013;2(1):12.
43. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review—a new
method of systematic review designed for complex policy interventions.
J Health Serv Res Policy. 2005;10 Suppl 1:21–34.
44. Rycroft-Malone J, McCormack B, Hutchinson AM, DeCorby K, Bucknall TK,
Kent B, et al. Realist synthesis: illustrating the method for implementation
research. Implement Sci. 2012;7(1):33.
45. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES
publication standards: realist syntheses. BMC Medicine. 2013;11(1):21.
46. Cayea D, Boyd C, Durso SC. Individualising therapy for older adults with
diabetes mellitus. Drugs Aging. 2007;24(10):851–63.
47. Sood A, Aron DC. Glycemic control in older adults: applying recent
evidence to clinical practice. Geriatr Aging. 2009;12(3):130–4.
48. Glasgow RE, Peeples M, Skovlund SE. Where is the patient in diabetes
performance measures? The case for including patient-centered and
self-management measures. Diabetes Care. 2008;31(5):1046–50.
doi:10.2337/dc07-1845.
49. Murad MH, Shah ND, Van Houten HK, Ziegenfuss JY, Deming JR, Beebe TJ,
et al. Individuals with diabetes preferred that future trials use patientimportant outcomes and provide pragmatic inferences. J Clin Epidemiol.
2011;64(7):743–8. doi:10.1016/j.jclinepi.2010.08.005.
50. Bowes A, Dawson A, Greasley-Adams C. Literature review: the cost
effectiveness of assistive technology in supporting people with dementia.
Report to the Dementia Services Development Trust: School of Applied
Social Science, University of Stirling 2013.
51. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes
care. Diabetes Care. 2006;29(3):725–31.
52. Kerr EA, Heisler M, Krein SL, Kabeto M, Langa KM, Weir D, et al. Beyond
comorbidity counts: how do comorbidity type and severity influence
diabetes patients’ treatment priorities and self-management? J Gen Intern
Med. 2007;22(12):1635–40.
53. Banningh LW, Vernooij-Dassen MJ, Vullings M, Prins JB, Rikkert MG, Kessels
RP. Learning to live with a loved one with mild cognitive impairment:
effectiveness of a waiting list controlled trial of a group intervention on
significant others’ sense of competence and well-being. Am J Alzheimers
Dis Other Demen. 2013;28(3):228–38. doi:10.1177/1533317513481093.
54. Dickson K, Lafortune L, Kavanagh J, Thomas J, Mays N, Erens B. Non-drug
treatments for symptoms in dementia: an overview of systematic reviews of
non-pharmacological interventions in the management of neuropsychiatric
symptoms and challenging behaviours in patients with dementia
https://eppi.ioe.ac.uk/cms/LinkClick.aspx?fileticket=qPNbVMn8JKQ%
3D&tabid=3335&mid=6487. Accessed date 29 December 2015.
55. Laakkonen ML, Holtta EH, Savikko N, Strandberg TE, Suominen M, Pitkala KH.
Psychosocial group intervention to enhance self-management skills of
people with dementia and their caregivers: study protocol for a randomized
controlled trial. Trials. 2012;13:133. doi:10.1186/1745-6215-13-133.
56. Parker D, Mills S, Abbey J. Effectiveness of interventions that assist caregivers
to support people with dementia living in the community: a systematic
review. Int J Evid Based Healthc. 2008;6(2):137–72. doi:10.1111/j.1744-1609.
2008.00090.x.
57. Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological
interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry.
2012;169(9):946–53. doi:10.1176/appi.ajp.2012.11101529.
58. Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D, et al. Clinical
effectiveness of a manual based coping strategy programme (START,
STrAtegies for RelaTives) in promoting the mental health of carers of family
members with dementia: pragmatic randomised controlled trial. BMJ. 2013;
347:f6276. doi:10.1136/bmj.f6276.
Bunn et al. Systematic Reviews (2016) 5:5 Page 7 of 8
59. Brooker D. Dementia care mapping: a review of the research literature. The
Gerontologist. 2005;45 suppl 1:11.
60. Brooker D. Person-centred dementia care: making services better. London:
Jessica Kingsley Pub; 2007.
61. Hughes JC, Bamford C, May C. Types of centredness in health care: themes
and concepts. Med Health Care Philos. 2008;11(4):455–63.
62. Nolan MR, Davies S, Brown J, Keady J, Nolan J. Beyond ‘person-centred’
care: a new vision for gerontological nursing. J Clin Nurs. 2004;13:45–53.
doi:10.1111/j.1365-2702.2004.00926.x.
63. Westhorp G. Using complexity-consistent theory for evaluating complex
systems. Evaluation. 2012;18(4):405–20.
64. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist synthesis: an
introduction, ESRC Research Methods Programme. Manchester: University of
Manchester; 2004.
65. Bunn F, Goodman C, Sworn K, Rait G, Brayne C, Robinson L, et al.
Psychosocial factors that shape patient and carer experiences of dementia
diagnosis and treatment: a systematic review of qualitative studies. PLoS
Med. 2012;9(10):e1001331.
66. Trivedi D, Goodman C, Dickinson A, Gage H, McLaughlin J, Manthorpe J,
et al. A protocol for a systematic review of research on managing
behavioural and psychological symptoms in dementia for communitydwelling older people: evidence mapping and syntheses. Syst Reviews.
2013;2:70. doi:10.1186/2046-4053-2-70.
67. Dixon-Woods M. Searching for studies in complex areas. http://documents.mx/
documents/searching-for-studies-in-complex-areas-mary-dixon-woodsdepartment-ofhealth-sciences-university-of-leicester-andrew-booth-universityof-sheffield.html. 2006. Accessed date 29 December 2015.
68. Greenhalgh T, Peacock R. Effectiveness and efficiency of search methods in
systematic reviews of complex evidence: audit of primary sources. BMJ.
2005;331(7524):1064–5.
69. IDOP. The hidden impact of diabetes in social care: report by the Institute
of Diabetes for Older People and Novo Nordisk 2013.

Permalink -

https://repository.canterbury.ac.uk/item/8v90v/managing-diabetes-in-people-with-dementia-protocol-for-a-realist-review

  • 0
    total views
  • 0
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

'Function first—be active, stay independent’—Promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design
Law, R-J, Williams, L., Langley, J., Burton, C., Hall, B., Hiscock, J., Morrison, V., Lemmey, A., Partridge, R., Lovell-Smith, C., Gallanders, J. and Williams, N. 2020. 'Function first—be active, stay independent’—Promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design. BMJ Open. 10 (2).
Understanding how and why de-implementation works in health and care: research protocol for a realist synthesis of evidence
Burton, C., Williams, L., Bucknall, T., Edwards, S., Fisher, D., Hall, B., Harris, G., Jones, P., Makin, M., McBride, A., Meacock, R., Parkinson, J., Rycroft-Malone, J. and Waring, J. 2019. Understanding how and why de-implementation works in health and care: research protocol for a realist synthesis of evidence. Systematic Reviews. 8 (194).
What works for whom in the management of diabetes in people living with dementia: a realist review
Bunn, F., Goodman, C., Jones, P. R., Russell, B., Trivedi, D., Sinclair, A., Bayer, A., Rait, G., Rycroft-Malone, J. and Burton, C. 2017. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Medicine. 15 (141).
Collaboration and co-production knowledge in healthcare: opportunities and challenges
Rycroft-Malone, J., Burton, C.R., Bucknall , T., Graham, I.D., Hutchinson, A. and Stacey, D. 2016. Collaboration and co-production knowledge in healthcare: opportunities and challenges. International Journal of Health Policy and Management. 5 (4), pp. 221-223.
Collective action for implementation: a realist evaluation of organisational collaboration in healthcare
Rycroft-Malone, J., Burton, C.R., Wilkinson, J., Harvey, G., McCormack, B., Baker, R., Dopson, S., Graham, I.D., Staniszewska, S., Thompson, C., Ariss, S., Melville-Richards, L. and Williams , L. 2016. Collective action for implementation: a realist evaluation of organisational collaboration in healthcare. Implementation Science : IS. 11 (17).
An occupational therapy intervention for residents with stroke-related disabilities in UK care homes (OTCH): cluster randomised controlled trial with economic evaluation
Sackley, C.M., Walker, M.F., Burton, C.R., Watkins,C.L, Mant, J., Roalfe, A.K., Wheatley, K., Sheehan, B., Sharp, L., Stant, K.E., Fletcher-Smith, J., Steel, K., Barton, G.R., Irvine, L. and Peryer, G. 2016. An occupational therapy intervention for residents with stroke-related disabilities in UK care homes (OTCH): cluster randomised controlled trial with economic evaluation. Health Technology Assessment. 20 (15).
Collective Action for Knowledge Mobilisation: a Realist Evaluation of the Collaborations for Leadership in Applied Health Research and Care
Rycroft-Malone, J., Burton, C., Wilkinson, J., Harvey, G., McCormack, B., Baker, R., Dopson, S., Graham, I., Staniszewska, S., Thompson, C., Ariss, S., Melville-Richards, L. and Williams, L. 2015. Collective Action for Knowledge Mobilisation: a Realist Evaluation of the Collaborations for Leadership in Applied Health Research and Care. UK NIHR Journals Library. doi:10.3310/hsdr03440
An untapped resource: patient and public involvement in implementation comment on "Knowledge mobilization in healthcare organizations": a view from the resource-based view of the firm
Burton, C. and Rycroft-Malone, J. 2015. An untapped resource: patient and public involvement in implementation comment on "Knowledge mobilization in healthcare organizations": a view from the resource-based view of the firm. International Journal of Health Policy and Management. 4 (12), pp. 845-847.
What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services
Burton, C.R., Horne, M., Woodward-Nutt, K., Bowen, A. and Tyrrell, P. 2014. What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services. Disability and Rehabilitation. 37 (21), pp. 1955-1960.