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.
Diabetic retinopathy is the second most common cause of vision loss and the leading cause of visual impairment
and blindness among working-age adults in the UK. There is sufficient evidence linking chronic suboptimal
blood sugar control with development and worsening of diabetic retinopathy in both type 1 and type 2 Diabetes.
Currently there are no best practice tariffs or initiatives to improve diabetes control once diabetic retinopathy
is diagnosed. The current model of diabetes care existent across UK supports more community based diabetes
care and many patients with known microvascular disease do not have access to specialist care. Separating
diabetes specialist appointments from the ophthalmology appointment perhaps does not clearly highlight
the importance of improving blood sugar control as the mainstay of treatment to this patient group.
To identify diabetic patients with suboptimal glycaemic control who have referable diabetic retinopathy in a district
general hospital eye clinic. Offering intervention in the form of education, treatment intensification or early referral
to secondary care. To measure the efficacy of intervention using A1c as surrogate marker of glycaemic control.
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