DISN UK Group Conference 2018
Diabetes by every other name……..
Tuesday 9th October 2018, Piazza Suite 1 & 2 NEC, Birmingham
The DISN UK Group 14th Conference in 2018 was a huge success with thanks to everyone who attended. The conference saw 50 delegates who gave fantastic feedback towards the highly respected professionals that presented ‘hot topic’ speeches. Massive thanks to the continued and generous support of our sponsors for making the conference possible year after year.
For those who weren’t able to attend, take a look at the presentations below….
Emily Watts – Diabetes UK
Road-map for the challenges facing Inpatient Diabetes Services
Emily introduced report ‘Making hospitals safe for people with diabetes’ launched Mon 8th October and is pleased to announce the good press coverage the report has received.
The report is inspirational and offers 6 goals to achieve, with evidence of shared practice for each goal.
There is a shared practice library available of the diabetes UK website; she also reports there is a diabetes healthcare e Learning module available for non-specialists.
Emily is optimistic that everything is aligning e.g. STP bid transformation fund, the above diabetes report, GIRFT inspections and soon to be published JBDS guidance on what a good inpatient diabetes service should be. Thus she strongly encourages you that now is a good time to bring diabetes to the forefront in your trust.
To read the full report follow the link –
Dr Siva Sivappriyan FRCP – Consultant Endocrinologist & Honorary Senior Lecturer, King’s College London Maidstone, Lead for foot service & young adult diabetes.
Diabetes by every other name including LADA, MODY, Ketone Prone and secondary
Dr Siva gave an excellent presentation encouraging the delegates to review some very limited detail case studies and consider what type of diabetes the patient may have including what other information/ tests you may consider and the cost of these tests – are they really necessary?
His slide set explained the different types of diabetes including T1, T2, Ketone prone, LADA and MODY. He also discussed NODAT (New onset diabetes after transplant) and ‘Brittle’ diabetes.
To view the full presentation click on the following link –
Diabetes by other names (1)
Dr Siva recommends the following links –
- Diabetesgenes.org/content/urine-c-peptide-creatinine-ratio (to learn likely type of diabetes from Diabetesgenes.org/content/urine-c-peptide-creatinine-ratioresult)
- Diabetesonthenet (He recommends the 1 hour free e-learning module about other types of diabetes, but says there are all the other excellent diabetes related modules)
- Diabetes Diagnostic App (Available on I Phone and Android, contains a MODY calculator)
Professor Gerry Rayman MD FRCP Consultant Diabetologist, Ipswich Diabetes Centre and Research Unit
Latest NaDIA results, GIRFT (Get It Right First Time) and other national inpatient initiatives.
Professor Rayman gave an informative background on the cost and state of current inpatient care with particular reference to how patients feel and the variation between trusts.
He then introduced NaDIA harms (which he hopes we will all sign up to) measuring serious hypos, DKA, HHS and new foot legions.
NaDIA 2017 Key message summary:
- 1 in 6 people with diabetes occupied an acute hospital beds this will may exceed 1 in 4 (25%) by 2030
- Staffing levels remain low and 57 hospitals had no DISN in 2017.
- Less than 10% have a weekend diabetes services
- The drive to the use of new technologies is lagging
- Admission avoidance and discharge planning are areas to be addressed if we are to reduce LOS
Improvements in diabetes inpatient care:
- Diabetes teams are managing to see more patients
- Reduced VIII, from 12.4% to only 8.2% (34%)
- Reduced all hypoglycemia episodes from 26 to 18% (30%)
- Reduced the need for rescue treatment of severe hypoglycemia – from 2.2 to 1.3 % (41%) avoiding an estimated 3,400 events per year
- Reduced medication, prescription, management and insulin errors
- Improved ‘Good diabetes’ days have by half a day
- Reduced patients developing foot ulcers during hospital stay – from 1.6 to 0.97 per cent (40%) avoiding 2,500 foot lesions
Areas where further improvement is needed:
- 30% who should be seen by a DISN are NOT SEEN
- Less than half of insulin treated patients have a ‘good diabetes day’.
- Medication errors – 31% and are more frequent on surgical wards
- Insulin errors – occurred in 40% of those treated with insulin
- In-hospital DKA- 1 in 25 people with Type 1
- Severe Hypoglycemia occurs in 1 in 4 people with Type 1 diabetes
- 1 in 80 requiring injectable rescue treatment
- Patient satisfaction with timing of and meal choice continue to worsen
Finally, he discussed GIRFT (Getting it right first time) he gave some background history of how it started in orthopaedics with 1 surgeon demonstration variation in practice followed by agreement to do things the same which resulted in a £5 million for that trust.
That surgeon was then able to persuade NHS improvement to fund him to look at other trusts which resulted in a nationwide £60 million saving, better patient care and less litigation. Other surgical specialties then followed suit, and now it is being rolled out to medical specialties with diabetes being the first.
The inspection team engages all relevant parties from the CEO to the jobbing clinicians. All trusts will get inspected, a form will be sent out to each trust with questions about your current service provision which will inform the discussion on the day. He recommends you fill out this form as truthfully as possible because part of the job of the inspection is to identify areas for improvement which your trust will then have a vested interest in helping you to improve.
Caroline Brooks – Diabetes Inpatient Specialist Nurse, Maidstone & Tunbridge Wells NHS Trust
Practical steroids workshop
Caroline’s interactive and very enjoyable presentation got the delegates thinking about the various types of steroids and the multiple conditions they are used in. Highlighting the complexity steroids bring to our workload and need to understand the different regimes and factors affecting their discontinuation.
View Caroline’s workshop presentation here –
Useful articles –
- Alabbood M, et al. Glucocorticoid-induced diabetes among people without diabetes: a literature review. Practical Diabetes 2018; 35(2):63-67
- JBDS-IP guidelines: Management of hyperglycaemia and (glucocorticoid) steroid therapy 2014
- Kempegowda P, et al. Are they high on Steroids? Tailored interventions help improve screening for steroid-induced hyperglycaemia in hospitalised patients. BMJ Open Qual. 2018; 7(1): e000238.
- Wah Cheung N Steroid-induced hyperglycaemia in hospitalised patients: does it matter? Diabetologia 2016 59:2507–2509
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