Changing pattern of GP referrals: experience from a community diabetes clinic
DOI:
https://doi.org/10.15277/bjd.2025.491Keywords:
type 2 diabetes, HbA1c, clinical acuity, co-morbiditiesAbstract
The management of type 2 diabetes (T2DM) has undergone significant changes in recent years, with a shift away from the hospital setting towards community–based teams. This study aimed to investigate changes in clinical acuity and complexity of patients with T2DM referred to the Sutton Community Diabetes Service.
This retrospective audit of patients with T2DM compared the first hundred patients referred in 2017, when local guidelines for referral were first introduced, with the first hundred patients referred in 2023. Demographic data, treatment modalities, diabetic complications and co- morbidities were retrieved from our EMIS database.
Compared to the 2017 cohort, patients referred in 2023 were more ethnically diverse (35% South Asian vs. 18%; p<0.01), had higher mean (SD) HbA1c levels (mmol/mol at referral 90.8 [20.6] vs. 81.5 [19.9, p <0.01), higher rates of microalbuminuria (47% vs. 28%, p=0.02),and were more likely to have three or more significant co-morbidities such as co-existent cancers or cardiovascular disease.
This study highlights the growing complexity of patients referred to the community diabetes service, which impacts on the entire multidisciplinary team. Commissioners and care planners need to consider the increasing complexity of patients managed in these settings.
References
National Diabetes Audit 2023–2024 Quarterly Report January 2023 to March 2024; accessed May 2025. www.digital.nhs.uk
Scottish Government, Riaghaltas na h-Alba, Cluster data and intelligence report—Type 2 diabetes mellitus in adults. Scottish General Practitioners Committee Royal College of General Practitioners, 12th June 2023.
Bagust A, Hopkinson PK, Maslove L, Currie CJ. The projected heath care burden of type 2 diabetes in the UK from 2000 to 2060. Diabet Med 2002;19(Suppl 4):1-5. https://doi.org/10.1046/j.1464-5491.19.s4.2.x
Sutton’s Strategic Needs Assessment (JSNA) Borough profile 2023 https://data.sutton.gov.uk/strategic-needs-assessment-jsna/
Morgan CL, Currie CJ, Hunt J, et al. Relative activity and referral patterns for diabetes and non-diabetes in general practice. Diabet Med 2000;17:230-5. https://doi.org/10.1046/j.1464-5491.2000.00208.x
Davis TME, Drinkwater JJ, Gerry Fegan P, et al. Community based management of complex type 2 diabetes: adaptation of an integrated model of care in a general practice setting. Int Med J 2021;51:62-68. https://doi.org/10.1111/imj.14669
Martin L, Hill S, Holt RIG. The effect of diabetes management on the workload of district and community nursing teams in the UK. Diabet Med 2024;41:e15367. https://doi.org/10.1111/dme.15367
London Strategic Clinical Networks. Improving the management of diabetes care: a toolkit for London clinical commissioning groups. https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2019/07/dia-moc-toolkit-062015.pdf
Khunti K, Aroda VR, Aschner P, et al. The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery. Lancet Diabetes Endocrinol 2022;10:890–900. https://doi.org/10.1016/S2213-8587(22)00278-9
Teljeur C, Smith SM, Paul G, Kelly A, O'Dowd T. Multimorbidity in a cohort of patients with type 2 diabetes. Eur J Gen Pract 2013;19(1):17-22. https://doi.org/10.3109/13814788.2012.714768. PMID: 23432037
Nowakowska M, Zghebi SS, Ashcroft DM, et al. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med 2019;17:145. https://doi.org/10.1186/s12916-019-1373-y
Glynn LG, Valderas JM, Healy P, et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract 2011;28(5):516-23. https://doi.org/10.1093/fampra/cmr013. Epub 2011 Mar 24. PMID: 21436204.
Bain S, Rickford A, Black N, et al. Delivering joined-up care for people with type 2 diabetes: rationale, challenges and examples. Br J Diabetes 2021;21(1):89-95. https://doi.org/10.15277/bjd.2021.294
Bayliss EA, Steiner JF, Fernald DH, et al. Descriptions of barriers to self-care by persons with comorbid chronic disease. Ann Fam Med 2003;1(1):15–21. https://doi.org/10.1370/afm.4.
Published
Issue
Section
License
Copyright (c) 2025 British Journal of Diabetes
This work is licensed under a Creative Commons Attribution 4.0 International License.
Manuscripts published in the June 2024 edition and after in the BJD have been published in open access under a Creative Commons Attribution 4.0 International License and available at https://www.bjd-abcd.com. Prior year articles are available free of charge via our website.
