Former National Clinical Director for Diabetes and ABCD Trustee Dr Hillson presented the Rowan Hillson Insulin Safety Awards to the winners of ‘the best in class’ insulin prescription chart on 6th November 2014 at the ABCD autumn conference.
The winner was Nottingham University Hospitals NHS Trust (Jenny Clayton), the runner-up was East Sussex Healthcare NHS Trust (Erwin Castro and Umesh Dashora) and the highly commended awards went to Worcestershire Royal Hospital (Joanne Shuck) and Western Sussex Hospitals NHS Foundation Trust (Naomi Burns). Winners and judges attended the conference dinner as our guests.
At the ABCD committee meeting in September several work streams were established to address priority areas for the coming year; Type 1 diabetes and the second instalment of the Lost Tribe campaign (Patrick Sharp to lead), diabetes and kidney disease, in conjunction with the Renal Association (Peter Winocour to lead), Parity of Esteem (Kate Fayers to lead). The new generation of ABCD Nationwide Audits of New Therapies are going ahead under the direction of Bob Ryder (see ABCD website and pages 143,147,163 in this issue). Importantly the Chairs for our sub-committees have been appointed; Dev Singh – Education and Professional Development, Hugh Jones – Academic. We are reviewing our communication strategy with the assistance of Andy Macklin.
Following the success of the implementation of the best practice tariff for paediatric diabetes in England there has been considerable interest in extending the tariff to include transitioning of care and young adults, commonly defined as up to age 25 years. ABCD is working closely with the National Clinical Directors for Diabetes and Children and Young people (with responsibility for transition).
ABCD is inviting adult and paediatric diabetologist colleagues to contact us with information about issues in their localities that are inhibiting effective transitional care. We also want to hear about and promote innovative models of care, especially those with evidence of improved engagement or clinical outcomes. Please contact Dr Peter Winocour at peter.winocour@nhs.net with any information (both positive and negative) on your local transition services that will inform the national drive to improve care for this important group of patients.
A joint writing group has been established to produce best evidence and consensus-based practical guidance for the management of lipid disorders, blood pressure (including RAAS blockade) and glycaemia in diabetes patients throughout the spectrum of diabetic nephropathy and CKD. The first document will focus on holistic diabetes care on the dialysis unit, and is scheduled for completion early in 2015. If any ABCD members wish actively to contribute to the writing groups, please contact Dr Peter Winocour at peter.winocour@nhs.net We will use the guidelines as a springboard for a campaign to raise awareness of kidney disease and diabetes, a priority topic for the Strategic Clinical Network Diabetes Leads, and for which Diabetes UK has pledged support.
ABCD now has a tool for worldwide audit which allows participation using the same methodology as when undertaking a nationwide audit on n3. The n3 exenatide tool is at the following address and one has to be on n3 (ie at work) to access it, see: http://n3.diabetologists.org.uk/exenatide-qw/. The worldwide audit tool is at http://wwaudit. diabetologists.org.uk/exenatide-qw/. The dapagliflozin audit was announced in mid October, to register please visit: http://www.diabetologists-abcd.org.uk/n3/Dapagliflozin_Audit.htm . To register for the dapagliflozin and exenatide qw audits with a single application go to http://www.diabetologists-abcd.org.uk/n3/n3_Audits_Register_ Both.htm.
The launch of the insulin degludec audit was announced in November at the ABCD autumn meeting – register at http://www. diabetologists-abcd.org.uk/Degludec/Degludec_Audit.htm
The Oxford Centre for Diabetes Endocrinology and Metabolism is conducting a survey to assess the management of hypoglycaemia in type 1 diabetes in different parts of the country. ABCD members are invited to participate on an anonymous basis. To take part please go to: https://www.surveymonkey.com/s/hypointype1
Members should be encouraged by the references to diabetes in the latest CQC report, ‘The state of health care and adult social care in England 2013-14’ published on 16 October. A JBDS team, including ABCD members Mike Sampson, Daniel Flanagan, Alan Sinclair, Gerry Rayman, Ketan Dhatariya and Rob Gregory, has been in ongoing discussions with CQC about the desirability of including diabetes-specific elements in its inspections, not only of Acute Trusts, but of the whole care pathway. We have another meeting planned in January 2015. Meanwhile look at pages 74-76 of the report in which CQC announces... ‘The second phase of our programme, to begin in 2015, will involve inspection activities and bespoke information gathering to follow up on the findings from the data review. This will explore in-depth at a local level the causes behind variations in care and outcomes for different people.’ ABCD members must expect to be asked questions about the diabetes services in their localities to assist CQC with its enquiries. See: http://www.cqc.org.uk/sites/default/files/state-of-care-201314-full-report.pdf
The APPG meeting in September was attended by ABCD’s chairman Rob Gregory . The meeting was to investigate the provision of education for people with diabetes from the patients’ perspective. The investigation will lead to a report with a series of recommendations. It is clear that patients are increasingly looking online for information to help them manage their diabetes, sometimes to supplement the education they have received from their local healthcare teams, and sometimes because there is no education available to them or they cannot access courses for various reasons. We have proposed legislation to compel employers to release emloyees to attend diabetes educational courses.
ABCD hosted a Tweetchat for #OurD, the Diabetes Online Community, which is a peer support network – mostly type 1 patients and carers – on 14th October. This was well- received and there seemed to be support from participants for our priorities – type 1 diabetes, and diabetes and mental ill health in particular. The next meeting of APPG is on 19th November and Chris Walton will attend for ABCD. The meeting will focus on diabetes education from the health professionals’ perspective. We have also been invited to submit written evidence.
We are looking for more mentors for the ABCD National Diabetes Consultant Mentorship Programme. This scheme aims to provide new consultant diabetologists with high quality structured mentorship when they take up their post. Mentors, who must have at least five years experience in a consultant role, are provided with training leading to accreditation. Mentors and mentees have evaluated the scheme highly, and it is becoming the victim of its own success. We now have mentees around the UK on a waiting list. We are particularly keen to hear from diabetes consultants in the East Midlands and Scotland who might be interested in volunteering as demand currently outstrips supply in these areas. To learn more please email the Programme Lead at baldev.singh@nhs.net.
The National Diabetes Audit published on 2nd October has shown that in England and Wales achievement of NICE targets for diabetes is particularly low in people under the age of 40yrs: 22% of people with type 1 diabetes and 16% with type 2 diabetes in this age group have an HbA1c > 86mmol/mol (10%). For details see: http://www.hscic.gov.uk/catalogue/PUB14970
A new implantable device for the delivery of exenatide has completed phase 3 of clinical trials. ITCA 650 is a mini pump, about the size of a matchstick, which is able to release medication for 6 or 12 months. At the end of its usable life the subcutaneous pump is removed. Over a 9 month period in the phase 3 trials HbA1c decreased by 37mmol/mol (3.4%) in patients with high baseline HbA1c (86-108mmol/mol; 10-12%): http://www.diabetes.co.uk/news/2014/oct/implantable-mini-pump-prevents-need-to-inject-incretin-medication-97716342.html
Health Innovation Network South London has developed an interactive toolkit to aid provision and implementation of education courses for diabetes. The toolkit shares innovative case studies and ideas including suggested key performance indicators, as well as outlining the various courses currently available to meet the needs of different communities. The toolkit can be found at: http://www.hinsouthlondon.org/system/resources/resources/000/000/047/original/Structured_Education_Toolkit_(Final).pdf?1412668611
ABCD has received news that the Derby flagship integrated diabetes scheme has been decommissioned. The Derby model features prominently in ‘Improving the Quality of Adult Diabetes Care through Integration’ published by Diabetes UK in October 2014. The decision comes as a shock to many in England who are at various stages of reconfiguring diabetes services along similar lines, and we urgently need to understand and learn from what led the commissioners to walk away.
The annual EuroDiabetes Index was published in September (http://www.healthpowerhouse.com/). The UK was 4th (scoring 812 out of 1000 points) in this ranking of diabetes care in the 28 EU member states (plus Norway and Switzerland). The UK was commended for its national diabetes audits in lieu of a national registry; NICE’s clear guidelines for diabetes management and quality procedures to monitor blood pressure, eye, kidney and foot complications. It was noted that the UK had variations in access to care and standards of care and a particular weakness was diabetes prevention; with the UK population perceived as obese and sedentary with poor dietary habits.
The 4th edition of Diabetes in Europe: The Policy Puzzle was launched on World Diabetes Day (14th November). The report monitors the changes in national policies for diabetes prevention and care in the 47 countries of the IDF Europe region, where 52 million people now live with diabetes. This collecting of data informs national policy frameworks to support high quality diabetes care: 30 countries now have a national diabetes register and 30 countries have adopted a national diabetes plan and a further 10 will have such a plan in the near future. The report is a useful resource for key diabetes stakeholders and policy makers in Europe, where about a quarter of the total international expenditure for diabetes care – 114 billon euros/~£90 billion – occurs and as many as one in three adults with diabetes is undiagnosed. See www.idf-europe.org
At this year’s annual ABCD SpR meeting there were two winners of the 2014 award for the best presentation: Dr Joanne Morling (Edinburgh) and Dr Sanjeev Sharma (Ipswich).
In October two new JBDS guidelines became available: JBDS 08, on the management of hyperglycaemia and steroid (glucocorticoid) therapy; and JBDS 09 on the use of variable rate intravenous insulin infusion (VRIII) in medical inpatients. Both guidelines can be accessed via the ABCD website (http://www.diabetologists-abcd.org.uk/JBDS/JBDS.htm)