DIABETES
more time on patient care and on supporting gPs to manage more patients in primary care. this means that lower risk patients can now be managed in the community in partnership with gPs • multidisciplinary clinics have been established in six locations to bring specialist integrated diabetes care closer to the community and, to date, 838 people have been seen. of those, 72 newly-diagnosed patients were then referred to urgent access clinics across the Western area. • of the people attending clinics, 150 were identified as at high risk of developing type 2 diabetes and preventative measures were put in place.
this integrated approach and the introduction of a centralised referral system has reduced the waiting time for an outpatient consultant review from nine months to one month as patients can be treated by the multidisciplinary team in the community.
place an integrated diabetic foot care Pathway to ensure early identification of problems and access to a multidisciplinary assessment for people with diabetes at risk of developing foot conditions.
the integrated approach involves gPs, community nursing, diabetes specialist teams and Allied health Professionals in primary and secondary care, and specific cooperation between medical and surgical teams for patients with acute diabetic foot problems.
diabetic patients in Belfast at risk of foot complications and amputation, meanwhile, now also have access to a multidisciplinary foot Protection team to manage and reduce the risk of
complications which can result in amputation.
Enhanced care throughout service Integrated working in terms of caring for diabetic patients hasn’t just been restricted to foot problems. the Western Area IcPs have also reformed the entire diabetes pathway and ensured a more integrated service by introducing a number of measures:
• Patient registers in hospitals and gPs practices have been reviewed to ensure that people with diabetes are receiving the right care in the right place at the right time • A more efficient referral system has been introduced using a single point of contact and electronic triage which has enabled consultants to spend
the statistics relating to diabetes in Northern Ireland are alarming: • diabetes care costs Northern Ireland more than £1 million per day, or ten per cent of the healthcare budget
• the number of people with diabetes doubled between 2003-2014 • over 85,000 people in Northern Ireland live with diabetes • People with diabetes are fifteen times more likely to need an amputation than the general population
• In 2014, 1,495 people with diabetes were admitted to hospital for amputations and end stage renal disease
• Approximately 150 major limb amputations are carried out in Northern Ireland every year of which about 80 per cent could be prevented
more than 500 people with type 1 or type 2 diabetes have also received structured patient education, and a similar patient education programme is now available to all patients with type 2 diabetes in Belfast.
Structured patient education empowers the patient with diabetes to better understand and manage their condition and medication on a day-to-day basis, and is especially beneficial to carers who may be managing tables and insulin on behalf of the person with diabetes.
In the Southern Area, meanwhile, 26 gPs, practice nurses, pharmacists and nutritionists have achieved a ‘diabetes management in Primary care’ diploma, which will enable them to tailor treatment to each patient in line with best practice and prevent the need for referrals to hospital.
Almost 180 children with diabetes in the same area have also been supported over 16 months by an out- of-hours diabetic Specialist Nurse Service, where families can ring a nurse for advice at any time of day or night, to avoid a potential attendance at the Emergency department.
great work throughout the Province – and great news for diabetic patients! •
moRE commUNIcAtIoN NEEdEd BEtWEEN dIABEtIc PAtIENtS ANd doctoRS A new survey has shown that only one in three patients has discussed symptoms of high blood glucose levels (hyperglycaemia) with their nurse or doctor. the survey looked at 200 people living with type 1 or type 2 diabetes, who need mealtime insulin to control their blood glucose levels.
the results are alarming in light of the fact that hyperglycaemia has a negative impact on a patient’s day- to-day physical and mental wellbeing. Reported symptoms of hyperglycaemia range from tiredness, thirst and needing to urinate frequently to difficulty concentrating, reduced productivity and irritability.
When asked why they chose not to discuss these symptoms with their healthcare professional, the reasons cited included: fear of being chastised for not taking their insulin properly and belief that they should be experienced enough to handle this chronic condition themselves.
‘the fact that many patients choose not to discuss their symptoms with their healthcare team suggests that we, as clinicians, need to be more proactive in asking about hyperglycaemia and better educate our patients on the importance of good mealtime control,’ said dr lalantha leelarathna, consultant diabetologist and honorary Senior lecturer at manchester diabetes centre, manchester Royal Infirmary.
‘Achieving good post-meal glucose control is challenging for many patients even when they follow current advice. As healthcare professionals, we need to better educate our patients and provide treatment strategies and solutions to minimise post-meal glucose excursions.’
of those surveyed, a third of people said they took their insulin during or after a meal. NIcE guidance, however, says that mealtime insulins should be taken before meals to control a post- prandial glucose (PPg) ‘spike’.
PhARmAcY IN focUS - 13
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