Improving glycaemic outcomes in newly diagnosed Type 1 diabetes adults
by Sheffield Teaching Hospital NHS Foundation Trust
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A 2014 audit of the Trust found that glycaemic outcomes for type 1 diabetes (T1DM) patients were sub-standard and potentially damaging. Even at one-year post-diagnosis, only 23% of patients were achieving the NICE target of <58mmol/mol vs 27% for all durations of T1DM in the 2012 National Diabetes Audit. The existing patient care pathway was reviewed, and a consensus exercise undertaken to develop a clear evidence-based protocol. Results show significant improvements in glycaemic control compared with those diagnosed 2012-2013, and there is a more than two-fold increase in the proportion of patients achieving the NICE target. Staff and patient feedback has been highly positive, with staff expectations often exceeded, and 85% of patients on the recommended insulin regimen.
"This is a great example of engagement and the innovation is the ability to implement a whole team change in mentality. The pathway is patient centred and takes a common sense approach to Type 1, leading to big improvements in patient experience. This pathway should be distributed around the country."
Save Sight – Impact of dedicated diabetes eye nurse specialist in diabetes retinopathy
by The Hillingdon Hospital
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The Hillingdon Hospital set up a service embedding a dedicated diabetes eye nurse specialist within the retinopathy treatment eye clinic, obviating the need for referring all patients with suboptimal glycaemic control. A Dedicated Diabetes Eye Nurse Specialist (DDENS) educated these patients and reviewed their diabetes treatments. In the cohort of 116 patients seen between March and December 2015, there was a reduction in median A1c from 89mmol/mol to 72mmol/mol in 102 patients. These results came in patients followed up for three months up to 12 months. Patients found the service acceptable, accessible and convenient. The caregivers found it more satisfying and efficient also. It is projected to save both the ophthalmology and diabetes specialist services money in the medium to long term while improving outcomes for patients.
"This is a simple, but effective, intervention that shows a good working relationship between ophthalmology and the diabetes team. The HbA1c reductions are impressive in a group that really matters."
Successful outcomes in gestational diabetes through group education pathway
by Basingstoke and North Hampshire Hospital NHS Foundation Trust
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Rising gestational diabetes and inconsistent patient and foetal outcomes in the Trust led to a redesign of its patient pathway for women with a positive oral glucose tolerance test. Women with a positive OGTT are offered an afternoon education session with a diabetes nurse, diabetes specialist midwife and dietician. They are taught home blood glucose monitoring and a review of monitoring data is carried out in a midwife-led clinic. Patient-reported outcomes show the shared learning experience reduced anxiety and was a positive driver to improve diet and lifestyle. Group education is extremely cost effective and peer support, standardisation of educational materials and quality control of education are now embedded.
"We are all facing a rising tide of GDM with limited resources. This intiative is an excellent attempt to provide quality care with efficiencies. It is simple, low tech, easy to transfer and has one of the most fantastic websites!"
Regional consensus for insulin pump and continuous glucose monitoring provision
by Northern England Strategic Clinical Networks
Northern England Clinical Networks’ regional Diabetes Network established a regional working group to improve value from insulin pumps. The group developed a consensus guideline on the use of Continuous Glucose Monitoring (CGM), which was adopted by local commissioners, thus providing clarity and enabling prompt access to diagnostic technology as well as a management and monitoring tool. The work generated modest financial returns to commissioners, improved the efficiencies within pump centres, provided clarity to diabetologists and expedited access to technology for monitoring and management for those people with diabetes with the most to gain.
"This is an impressive regional consensus on the use of pumps and Continuous Glucose Monitors. It is an excellent example of clinical and commissioner partnership working. The ability to gain consensus for such expensive technology is an achievement and they are quite appropriately cited as an example of excellence by NICE."