Presents a complex set of problems with no one solution

The prevalence of diabetes in the elderly is around 10% and it imposes an enormous burden on healthcare systems. In America in 1992 nursing home care for people with diabetes cost $1.83 billion.1 Elderly diabetics have much microvascular and macrovascular disease and are two to three times more likely to need hospital admission than their non-diabetic counterparts.2 One might expect a higher prevalence of diabetes and its complications in residential or nursing homes. Several American studies have found diabetes in 20% of nursing home residents,3 and in one almost 90% of diabetic residents had coronary artery disease, strokes, or peripheral vascular disease—with 6.4 major diagnoses compared with only 2.4 in non-diabetic residents.4 In Alabama (and probably England) nursing home patients generate a disproportionately large number of out of hours calls.5

In a recent issue of the BMJ Benbow and coworkers surveyed 44 residential and nursing homes in Liverpool comparing 109 diabetic residents with 107 age and …