While the COVID-19 pandemic has highlighted a number of pre-existing challenges in delivering diabetes care in the NHS, some of the innovative approaches taken to continue patient management during the pandemic need to be retained to improve ongoing care, say UK experts.
The research was presented during the Diabetes UK Professional Conference: Online Series on October 27, in a session dedicated to the remodelling of diabetes services during the COVID-19 pandemic.
Nicola Milne, a community diabetes specialist nurse with Manchester University NHS Foundation Trust said that, prior to the COVID-19 pandemic, diabetes care “very much focused on face-to-face consultations”, with the majority “really rigid” 30- to 40-minute appointments every 3 to 6 months.
“But was that working? We knew we were starting to face a number of challenges,” she said.
These included increasing numbers of patients, the increasing complexity of diabetes care, poor uptake of structured diabetes education, and the need for access to advances in technology.
Alongside, there were challenges around healthcare service capacity, as well as with workforce recruitment and retainment, with Milne saying that a recent survey found there was a 10% vacancy rate for diabetes specialist nurses.
Variation in Care
The arrival of the COVID-19 pandemic only served to heighten these challenges.
Initial guidance issued on 23 March – around the time of the UK-wide lockdown – recommended that inpatient diabetes services should continue and may need to be increased to a 7-day service.
However, secondary care services, including diabetes foot, and pregnancy and diabetes services, were to be kept to a safe minimum, while group-based face-to-face contact was to be avoided.
Nicola Milne said that a survey by Diabetes UK in August revealed there was consequently “considerable variation” in diabetes inpatient care during the first peak of the pandemic.
Some trusts were able to adapt to the circumstances and provide a proactive, flexible service that relied on increased use of technology and maximised the number of days worked, while others saw their care comprised, particularly when their diabetes teams were disbanded and redeployed.
The result for Milne’s community service was that it had a 55% reduction in capacity due to staff shortages, but was required to perform an additional 580 type 2 diabetes reviews as a result of early hospital discharge, admission avoidance, and a reduction in outpatient services.
However, data from a study published in The Lancet showed that a disproportionate number of diabetes patients died from COVID-19 infection, and that both type 1 and type 2 diabetes were significant independent predictors of COVID-19 mortality.
Nicola Milne said that this underlined how frontline diabetes services need an effective ‘back line’ of community and outpatient services and remote consultations.
Moreover, there is a “need” for patient triage and risk stratification to ration overstretched and restricted services.
“This is really uncomfortable for us as healthcare professionals because we always want to give 100% to 100% of the people we’re caring for,” she said, “but we have got to accept that we are going