ABCD position statement on risk stratification of adult patients with diabetes during COVID-19 pandemic
At the time of submission of this manuscript, the COVID-19 pandemic had cost nearly 60,000 lives in the UK. This number currently stands at over 120,000 deaths. A high proportion (one third) of these lived with diabetes. The huge acute and emergency medicine effort to support people with COVID-19 has had a major knock-on impact on the delivery of routine clinical care, especially for long-term conditions like diabetes.
Challenges to the delivery of diabetes services during this period include a reduction in medical and nursing staff, limitations placed by social distancing on physical clinical space, and balancing virtual vs face-to-face care. There is a need to re-group and re-organise how we deliver routine out-patient adult diabetes services during the ongoing COVID-19 pandemic. We offer some suggestions for how patients can be stratified into red (urgent), amber (priority) and green (routine) follow up with suggestions of how often people should be seen. We also offer recommendation on how we can identify those at highest risk and try and minimise the long- term impact of COVID on diabetes care
During the COVID pandemic we have seen things happen in days that previously took years. The restart of diabetes services has triggered a more widespread use of virtual consultations and data management systems, but also offers an opportunity for more joined-up and cohesive working between primary and specialist care. While we do our best to keep our patients and colleagues safe, this pandemic is already proving to be a catalyst for change, accelerating the appropriate use of technology in diabetes care and implementing innovative solutions. To achieve this aspiration, further work – currently led by the Association of British Clinical Diabetologists in collaboration with Diabetes UK and the Primary Care Diabetes Society – to make recommendations on future proofing diabetes care in UK is in progress.
Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020;8(6):546–50. https://doi.org/10.1016/S2213-8587(20)30152-2
NHS England, Association of British Clinical Diabetologists, Royal College of Physicians. Clinical guide for the management of people with diabetes during the coronavirus pandemic. 2020 (accessed 11 April 2020). https://abcd.care/announcement/delivering-diabetes-and-endocrine-services-acute-nhs-trusts-during-covid-19-pandemic
Nagi DK, Choudhary P, Wilmot E, Winocour P. Supporting people with diabetes during the COVID-19 pandemic without face-to-face appointments. Br J Diabetes 2020;20(1):1–4. https://doi.org/10.15277/bjd.2020.246
GOV.UK. 2020. Guidance National Lockdown: Stay at home. https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing/staying-alert-and-safe-social-distancing (accessed 10 June 2020).
Barron E, Bakhai C, Kar P, et al. Type 1 and type 2 diabetes and COVID-19 related mortality in England: a whole population study. Lancet Diabetes Endocrinol 2020;8(10):813-22. https://doi.org/10.1016/S2213-8587(20)30272-2
NHS England. Coronavirus (COVID-19) in the UK. 2020 (accessed 15 June 2020). https://coronavirus.data.gov.uk/
Choudhary P, Wilmot E, Owen K, et al. Letter to the Editor: A roadmap to recovery: ABCD recommedations on risk stratification of adult pateints with diabetes in the post COVID-19 era. Diabet Med 2020;e14462. http://dx.doi.org/10.1111/dme.14462
Klonoff DC, Umpierrez GE. Letter to the Editor: COVID-19 in patients with diabetes: risk factors that increase morbidity. Metabolism 2020; 108:154224. https://doi.org/10.1016/j.metabol.2020.154224
Academy of Medical Royal Colleges (AOMRC). Principles for reintroducing healthcare services COVID-19. 2020. https://www.aomrc.org.uk/reports-guidance/principles-for-reintroducing-healthcare-services-covid-19/ (accessed 10 June 2020).
My Diabetes My Way (MDMY). Type 1 diabetes platform for NHS England launched. 2020 (accessed 13 June 2020). https://www.nhs.uk/apps-library/my-diabetes-my-way/
Rodriguez KM. Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator. Clin Ther 2013;35(2):170–8. https://doi.org/10.1016/j.clinthera.2013.01.002
Association of British Clinical Diabetologists. COVID-19 (Coronavirus) information for healthcare professionals. 2020. https://abcd.care/coronavirus
Association of British Clinical Diabetologists, Society for Endocrinology. Delivering diabetes and endocrine services in acute NHS Trusts during Covid 19 pandemic reset. May 2020. https://abcd.care/sites/abcd.care/files/articles/ABCD-SfE-working-group-V4.1.pdf
NHS. Clinical guide for the management of remote consultations and remote working in secondary care during the coronovirus pandemic. 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/ 03/C0044-Specialty-Guide-Virtual-Working-and-Coronavirus-27-March-20.pdf
Chaplin S. National Diabetes Audit 2015–2016 shows variations in care processes and targets. Pract Diabetes 2017;34(2):58-60. https://doi.org/10.002/pdi.2081
NHS England. Care processes and treatment targets, January to December 2019. 2019. https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/national-diabetes-audit-quarterly-report-january-to-december-2019 (accessed 15 June 20)
Ahn DT. The COVID-19 pandemic: a "Tech"-tonic shift toward virtual diabetes care. J Diabetes Sci Technol 2020;14(4):708–9. https://doi.org/10.1177/1932296820929719
Fatehi F, Martin-Khan M, Smith AC, Russell AW, Gray LC. Patient satisfaction with video teleconsultation in a virtual diabetes outreach clinic. Diabetes Technol Ther 2015;17(1):43–8. https://doi.org/10.1089/dia.2014.0159
Greenhalgh T, Vijayaraghavan S, Wherton J, et al. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open 2016; 6(1):e009388. https://doi.org/10.1136/bmjopen-2015-009388
Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol 2017;11(5):1015–27. https://doi.org/10.1177/1932296817713506
Sharma S, Kerry C, Atkins H, Rayman G. The Ipswich Touch Test: a simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration. Diabet Med 2014;31(9):1100–03. https://doi.org/10.1111/dme.12450
Kruger J, Brennan A, Thokala P, et al. The cost-effectiveness of the Dose Adjustment for Normal Eating (DAFNE) structured education programme: an update using the Sheffield Type 1 Diabetes Policy Model. Diabet Med 2013;30(10):1236–44. https://doi.org/10.1111/dme.12270
Hopkins D, Lawrence I, Mansell P, et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the UK DAFNE experience. Diabetes Care 2012;35(8):1638–42. https://doi.org/10.2337/dc11-1579
Rayman G, Kar P. Diabetes: GIRFT Programme National Specialty Report. https://www.gettingitrightfirsttime.co.uk/wp-content/uploads/2020/11/GIRFT-diabetes-report.pdf
Publish & Transfer of Copyright Agreement
For the mutual benefit and protection of the Author and the Journal Owner/Publisher it is necessary that the Author provides formal written Consent to Publish and Transfer of Copyright before publication of the Work.