DIABE T E S
Paediatric diabetes care during the pandemic
Dr. Carrie Mackenzie describes the experience of the Sheffield Children’s Hospital Diabetes team in delivering effective care for children and young people, overcoming the challenges posed by COVID-19.
In March 2020 the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and a public health emergency of international concern. The pandemic has created unprecedented difficulties in delivering diabetes care with fear of COVID-19 playing a large part in the reluctance of service users to access routine and urgent medical care.
The decision to suspend all non-essential
face-to-face patient contacts was made nationally by the NHS in March 2020 with immediate effect and with no specific prior planning leaving individual clinical teams to come up with rapidly implemented innovative ways of working in order to ensure that young people and their families could still access appropriate effective care and that clinical outcomes were not adversely affected. The Sheffield Children’s Diabetes Team were determined to find ways to ensure the best possible care to our service users during the pandemic. We were also keen to assess the effect of ‘lockdown’ on glycated haemoglobin (HbA1c) which is tested routinely every three months to monitor the long-term control of diabetes mellitus.
HbA1c not only provides a reliable measure of chronic hyperglycaemia but also correlates well with the risk of long-term diabetes complications.
The families of children and young people with diabetes were contacted and urged to download their insulin delivery, continuous glucose monitoring and blood glucose testing devices at home and to share their data wherever possible using a variety of available media including: Diasend/ Glooko; Tidepool; Clarity and LibreView. This enabled healthcare professionals to access the information needed to make clinical decisions. For those unable to download their devices at home for any reason and for those recently diagnosed or requiring an
MARCH 2021
is normal practice for our team and the usual package of in-patient care has been delivered with subsequent face-to-face and virtual education sessions provided after discharge.
An example of a patient attending the ‘drive by’ clinic to both download their blood glucose meter and do a finger prick blood sample for HbA1c analysis.
interpreter, face-to-face appointments were offered in an out-patient clinic on our non- acute hospital site. The families were invited to attend with a maximum of one carer per patient and were screened on arrival by clinic staff using our Trust’s standard COVID-19 screening questionnaire.
Out-patient consultations were then conducted by appointment only with strict social distancing, the wearing of face coverings by families and the use of appropriate personal protective equipment by all staff. For other families reluctant to attend a
face-to-face appointment in clinic we also offered the option to ‘drive-by’ for device downloading and HbA1c sample collection via an open car window and a subsequent telephone consultation once they reached home again. For those able and willing to download their devices at home we also offered the option of returning a postal HbA1c sample to avoid the need for a journey to hospital premises for a ‘drive-by’. Throughout the pandemic newly diagnosed patients have been admitted as
All planned sessions with our psychologist and diabetes educators have also continued virtually throughout via various virtual platforms as the requirement for social distancing has rendered our usual diabetes administrative base and education space unsuitable for patient contact by virtue of its small size hence team members have been forced to work from home. Any patient in need of urgent or emergency in-patient hospital care has been admitted to our acute hospital site in the usual way. At the start of lockdown, we embraced the challenges presented to service delivery by the pandemic restrictions as part of our ongoing Quality Improvement (QI) work and the progress with home downloading of devices, ‘drive-by’ downloading and HbA1c and postal HbA1c sampling was reviewed at our QI meetings which are held twice a month.
This enabled us to maintain team coherence in achieving shared aims and to share concerns about operational issues and review data collected in real time to sense check the process and fine-tune the logistics. This project was an excellent example of the team’s willingness to “be brave and fail fast” which has been key to our QI success in improving outcomes for children and young people with diabetes.
Postal Hba1c
The collection of finger prick blood samples at home posted by families to the hospital laboratory for HbA1c analysis was used previously by our team before routine point-of-care testing became available in our out-patient clinics. One of our senior diabetes educators approached the laboratory staff to explore the logistics of reinstating the postal HbA1c service and with the prompt
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