Well, what an extraordinary year it has been. As we enter the winds of a second pandemic wave, I reflect on my first few months in office as Chair of the ABCD. It occurs to me just how much we have had to adapt, not only as clinicians and diabetologists but also as a Society. I would firstly like to pay tribute to the fantastic efforts made by all our members and all others to keep our patients safe and well. We have all had to change the way we work immeasurably and are still coming to terms with this.
It is through the efforts of our previous Chair, Dr Dinesh Nagi, to whom I must acknowledge, that we were able to respond so quickly, as a Society, to the coronavirus pandemic. His proactive approach at ABCD, with support and guidance from our excellent executive trio, has helped us to adapt quickly and to develop and deliver tools and resources in a timely manner to support members to look after patients. We have worked closely with other societies, the Royal College and NHS England to help coordinate much of the information that we all received.
I would like to take this opportunity to thank all of our committee members, both past and present, for their time and dedication in supporting the development of new resources. Our Concise advice on Inpatient Diabetes (COVID) resources were put together by a robust expert team, led by Professor Gerry Rayman, who deserve much thanks. These have been extremely well received and our coronavirus web pages have seen traffic to our website rise substantially as the resources have become more widely disseminated and used across UK healthcare (https://abcd.care/coronavirus). The ABCD COVID-19 audit team should be recognised as having worked well to build templates and receive data in over 2,500 patients to date. I hope this will help us better determine predictors of outcomes and help our overall learning.
During the last six months we have continued to operate as a virtual organisation, with all committee and trustee meetings taking place virtually. This has assisted us to continue full operational working and we are delighted to have been able to support our members and colleagues with a series of webinars covering a range of topics from managing diabetes in care homes to language matters and also featuring two COVID specific webinars. The webinars have been very successful and are also available on demand via our website for you to watch at your leisure (https://abcd.care/abcd-webinars-series). There are plans to develop a monthly programme in 2021.
In addition to webinars, we have held an extremely successful multidisciplinary virtual Yorkshire regional meeting for over 150 delegates and will be running a second Midlands regional meeting on 26 November (https://abcd.care/events/abcd-regional-meeting-midlands). These meetings, which are free to attend, have proved to be rather effective and have been very well received by members and non-members alike. We hope we can take the learning from this new digital environment to be able to offer more virtual events in future, saving you time and money and helping towards a greener more sustainable future in the comfort of your front room or office.
We have just completed delivery of educational sessions in a dedicated ABCD virtual theatre at the Diabetes Professional Conference 2020 which appears to be an overwhelming success. Thanks to Dr Umesh Dashora and the DPC team for their efforts in achieving this.
As a result of the pandemic we were unable to host our conference in the traditional format. Whilst we will all miss the opportunity to meet up and network with our colleagues, we are delighted to be able to bring you the 2020 conference in a virtual format to be held on 16 December 2020. Featuring many of the opportunities of a face-to-face event, this year’s conference will be hosted on an interactive web platform featuring exclusive graphics to help make you feel ensconced in a conference virtual reality. Featuring a main auditorium with the latest updates by leading experts (https://abcd.care/spring-meeting-2020/programme), the conference is the go-to event for those working in diabetes and endocrinology. There will be clinical sessions, abstracts, breakout workshops for Specialist Registrars featuring leadership, service development and research.
Our secretariat has worked hard to bring us features of an exhibition area where you can visit exhibitor booths and download new and additional content to your very own ‘swag bag’. There’s a poster area too where you can watch video presentations by abstract authors and view posters. Most importantly, the platform allows you to network and chat with colleagues by text, audio and video – it’s almost as good as being there without having to leave the comfort of your own home and at very low cost. Please try to join us for this new event. For more information visit https://abcd.care/events/abcd-conference-2020.
Our Diabetes Technology Network (DTN) continues to go from strength to strength and this year, in spite of COVID-19, the group have managed to excel themselves with the launch of The Academy (https://abcd.care/dtn/education-healthcare-professionals), a CPD accredited educational platform where you can learn about the latest in diabetes technology. The Best Practice Guides (https://abcd.care/dtn/best-practice-guides) published by DTN have been extremely well received and they have also released some Top Tips on Technology issues (https://abcd.care/dtn-uk-top-tips) which are most valuable. A CGM education programme was also launched this year and features a host of educational videos and user stories on CGM (https://abcd.care/dtn/CGM). We are developing a virtual showroom for corporate supporters to demonstrate their devices. DTN will host this virtual conference using the same platform as ABCD, which is scheduled to be held on Tuesday 15 December. Find out more at https://abcd.care/events/abcd-dtn-uk-meeting-2020.
This year we have also taken the opportunity to make some additional website developments, as our website is more important than ever in this digital world:
As Chair of the ABCD, I would like to take this opportunity to extend warm thanks to all our corporate sponsors of both ABCD and DTN, without whom none of the programmes and supporting activities would be possible:
To show your support to them, I request that you all visit their booths when you join our conference.
Finally, I wish you all a very Happy Christmas and here’s hoping that Santa brings us all something nice to tide us over until the long-awaited vaccine arrives. We can then restore the services our patients need and continue positive transformation and education with the speed, innovation and enthusiasm that this pandemic has brought to us. Equally important, we will again be able to interact with each other with a warm visible smile.
Stay well and stay safe.
Dipesh Patel, ABCD Chair
https://abcd.care/announcement/winners-rowan-hillson-inpatient-safety-award-2019
Many thanks for submitting your entry for the Rowan Hillson Inpatient Safety Award for this year focused on the best perioperative pathway. This JBDS–IP project was led by Umesh Dashora and Erwin Castro. The submissions were judged against predetermined criteria by an independent panel constituted by Clare Crowley, Ketan Dhatariya, Lucy Fermor, Nicholas Levy and Dimitri Poumaras and chaired by Rowan Hillson.
Dr David Burkett St Laurent, Consultant Anaesthetist, Royal Gwent Hospital won the award. Dr Hillson appreciated the excellent description and careful analysis of the team’s project which completely restructured existing care for people with diabetes undergoing surgery. The new care plan, from preoperative optimisation through surgery and hospital stay where required, was based on JBDS guidance. Some extracts from the entry read: “Prior to the new pathway no diabetes management plans were generated for patients; now 100% of patients have a generated plan. 1000 standardised pre-assessment plans were completed by 60 different clinicians in the year April 18– April 19.” In one hospital, 91% of those with HbA1c >69 mmol/mol had better glycaemic control by the time of surgery. Two patients so improved their health that their surgery was no longer needed. One patient said: “I feel the best I have ever felt since my diabetes control has improved”. No extra resource was required.
Close on the winners’ heels were Dr Nicola Leech and the team from Newcastle Upon Tyne Hospitals Foundation Trust with ‘Making Surgery Safer for people with Diabetes’. This Trust has over 76,000 surgical episodes a year among which 15% are in people with diabetes. Having found that the surgical wards were the highest risk areas for diabetes care in the Trust, “Improving peri-operative diabetes care was identified as a key priority when the Trust enrolled in the national Sign-Up-to-Safety campaign”. The 3-year project used national guidance to transform processes for the patient journey from referral to discharge, directing diabetes specialist care to those who needed it. Working with the IT department included the electronic sugar cube alert system. Electronic insulin alerts ensured pharmacy intervention where needed and errors and hypoglycaemia were reduced. Overnight stays reduced from 35% to 15%. The MDT leadership group continues to meet every 6 weeks.
Many thanks to all those who participated in this competition and helped run it. Hopefully, other Trusts will get inspiration and share their project in next year’s competition.
These awards will be virtually presented at the national ABCD meeting on 16 December. The outcome of this initiative will be published on the ABCD, Diabetes UK and DISN UK Group websites to share excellent practice.
The award for next year is already announced on the topic of ‘Best intervention during the COVID-19 pandemic that has maintained inpatient safety for people with diabetes.’ https://www.diabetes.org.uk/professionals/news--updates/rowan-hillson-inpatient-safety-award-2021
It is vital that all healthcare professionals understand why cardiac and renal risks require BOTH measurements of urine albumin creatinine ratios AS WELL as eGFR. ABCD and the Renal Association and colleagues from primary care have agreed a consensus document on screening for kidney disease that is designed for use in all healthcare settings. We encourage this to be shared with all colleagues in integrated diabetes care services, in order to help improve the frequency of full screening for both aspects of renal damage.
ABCD has produced more guidance on the use of SGLT-2 inhibitors in people with diabetes.
https://abcd.care/resource/sglt-2-inhibitors-people-type-2-diabetes
A newly formed group by specialists from cardiac, renal and diabetes societies is working together to improve care of people with multiple co-morbidities. It has produced excellent guidance on cardiovascular risk reduction strategies for healthcare professionals who are not diabetes specialists.
A study led by UCL academics shows that clinical research capacity may have decreased by up to 87% in England at the peak of the coronavirus pandemic. The group estimates that, at the peak of the pandemic in April, less than 13% of full-time clinical academics in England would have been available to conduct research.
https://www.ucl.ac.uk/news/2020/aug/clinical-research-reduced-87-cent-peak-pandemic
The Government has announced a new package of measures to help individuals lose weight, protect themselves against COVID-19 and protect the NHS. Obesity remains one of the biggest health challenges in England, with obesity-related illnesses costing the NHS £6 billion a year. Currently, 63% of adults are overweight or living with obesity, and one in three children are overweight or obese. The need to tackle obesity has gained new importance due to the link between the disease and COVID-19. Nearly 8% of critically ill patients with COVID-19 in intensive care units have been morbidly obese compared with 2.9% of the general population.
As you will have seen, the key policies include plans for new laws to require large food and drink outlets to add calorie labelling for food and alcohol, bans for advertising of foods which are high in fat, sugar or salt before 9pm and ending ‘buy one get one free deals’. From the NHS perspective, there were more key policies of interest:
A rapid-fire collection of interesting recent developments in diabetes
It has been a busy few weeks for the DTN. We are so pleased to finally launch the ACADEMY program along with our partners Diasend/Glooko. More than 200 accounts have already signed up for ACADEMY, and your accounts will be turned live over the next few days. If you haven't already, sign up here:
https://abcd.care/dtn/education-healthcare-professionals
In the first phase we have educational videos about continuous glucose monitoring (CGM), technology in pregnancy, self-monitoring of blood glucose and virtual consultations. We believe this will be really important to see different members of the team sign up, as NHSE have asked us for the data on sign up and how many people complete the education.
We also launched a survey about how different teams are coping with the new normal of virtual consultations and what impact this has had on our ability to provide patients with the technology they want. If you haven't already done so, please fill this in
https://abcd.care/dtn/survey2020/
We hope to share the results at the DTN day on 15 December 2020. Speaking of which, sadly we will not be able to meet you and discuss things in person, but we have a fantastic virtual program set up so do sign up here:
https://abcd.care/events/abcd-dtn-uk-meeting-2020
We hope we can discuss the issues of the moment, from virtual healthcare to CGM in pregnancy and the usual workshops. We have a fantastic online platform that we hope will encourage interactivity, enabling you to discuss questions in your mind with colleagues.
Till the next report ...
Dr Pratik Choudhury and Dr Alistair Lumb
Diabetes Technology Network UK
Contact: pratik.choudhary@leicester.ac.uk
This is only a brief update – because COVID has stopped the majority of our courses and we are trying to adapt to the virtual environment we find ourselves in. Despite this, the YDEF committee is continuing to develop courses and opportunities for SpRs and young consultants. Little has changed since the previous update except perhaps a few extra grey hairs from the last few months!
Firstly, we were pleased to be able to support the speciality advisory committee at the Royal College of Physicians in the development of the new curriculum for trainees. The draft version should be available for sharing in the coming weeks. We also have taken this opportunity to survey trainees nationally to try providing evidence of problems we encounter with training, or those that might develop in the future if access to tertiary centres is reduced in the shift to Internal Medicine Training (the new Core Medical Training) and the introduction of IMT3. We have some provisional results which we are hoping to publish and share in the coming months and that we hope provokes thought about what needs to be done in every area of the country to provide some protected training without the often-time-consuming commitment to general medicine rotas or ward work.
We were really pleased to be able to run an Obesity webinar jointly with the Association for the Study of Obesity (ASO) – this was well attended and greatly received. This is an important topic and something which are planning to focus more resources on in future. Our initial plan for a 2-ay course was scuppered by the virus, but we plan to go ahead with this in some form (virtual or in-person) in 2021.
COVID has also allowed us to work more closely with ABCD. We are really excited about our joint venture, supported by Lilly pharmaceuticals, for monthly webinars aimed at Diabetes & Endocrine SpRs. We hope this will fill the gaps left from the training opportunities that we have lost due to COVID rotas and general medicine on-call commitments.
Finally, another joint venture. We are really pleased that alongside the British Journal of Diabetes we are launching a Quality Improvement Project award. We have all had to make significant changes to our services and some of the results have been impressive. There is no better way of sharing your work than writing these up and submitting for consideration (and there is an associated prize of £250 for the top 3 pieces or work as well as publication!). This is a fantastic opportunity for an SpR, early consultant or diabetes MDT member and we really hope people submit their projects and inspire other centres to think about how they might improve their services as well!
Dr Tim Robbins on behalf of YDEF Committee
University Hospitals Coventry & Warwickshire NHS Trust, UK
Contact: drtrobbins@gmail.com