Delivering joined-up care for people with type 2 diabetes: rationale, challenges and examples

Authors

  • Steve Bain Institute of Life Science, Swansea University Medical School, Singleton Park, Swansea, UK https://orcid.org/0000-0001-8519-4964
  • Alice Rickford Lambeth Diabetes Integrated Care Team, Crown Dale Medical Centre, London, UK.
  • Neil Black Department of Endocrinology and Diabetes, Altnagelvin Hospital, Derry/Londonderry, UK https://orcid.org/0000-0003-3167-422X
  • Lesley Hamilton Western Health and Social Care Trust, Altnagelvin Area Hospital site, Derry/Londonderry, UK
  • Elizabeth Camfield Guy’s and St Thomas’ NHS Foundation Trust, UK
  • Mark Chamley Lambeth Diabetes Integrated Care Team, Crown Dale Medical Centre, London, UK
  • Anna Hodgkinson Lambeth Diabetes Integrated Care Team, Crown Dale Medical Centre, London, UK
  • Janaka Karalliedde Lambeth Diabetes Integrated Care Team, Crown Dale Medical Centre, London, UK. Guy’s and St Thomas’ NHS Foundation Trust, UK. School of Cardiovascular Medicine and Sciences, King’s College London, London, UK. https://orcid.org/0000-0002-2617-8320

DOI:

https://doi.org/10.15277/bjd.2021.294

Keywords:

type 2 diabetes, cardiovascular disease, chronic kidney disease, multidisciplinary care, general practice

Abstract

Approximately 3.8 million people in the UK have type 2 diabetes mellitus (T2DM) and are, as a consequence, at risk of developing micro- and macrovascular disease. The rapid increase in T2DM prevalence places a considerable burden on secondary healthcare. New classes of glucose-lowering medications (sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists) can improve macrovascular outcomes for people with T2DM; however, these options have brought another layer of complexity to managing this disease. In combination, these factors are calling into question the suitability of the primary–secondary care healthcare model and prompting healthcare professionals to investigate alternative solutions. Bringing high-quality care to people with diabetes and meeting their complex needs requires integrated multidisciplinary expertise in the community. However, setting up such systems within the National Health Service (NHS) can be challenging. The complexities of the internal market (in NHS England), lack of training and expertise, inadequate information technology systems and resistance to change on a systemic and individual level all constitute significant barriers to establishing easy-to-access integrated care. When barriers are removed, successful integrated care systems can be established, which improve care for people with diabetes and alleviate pressure on secondary care centres.

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Published

2021-05-28

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Learning from practice