Guidelines for the management of diabetes in care homes during the Covid-19 pandemic

Abstract

The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.

Keywords: Covid-19; Diabetes; care homes; frailty; insulin; residents.

FIGURE 1

Suggested initial actions in different clinical scenarios *please liaise with your local community nursing team and/or diabetes specialist nurse for advice to manage the resident; **for example, canagliflozin, dapagliflozin, empagliflozin; ***for more detailed advice, please visit: https://abcd.care/coronavirus; monitoring frequency and glucose target range dependent on shared decision making, staff resources and health status of resident