Using pharmacists to help improve care for people with type 2 diabetes

drug-1674890_1280The Royal Pharmaceutical Society (RPS) has published Using pharmacists to help improve care for people with type 2 diabetes.  This document is aimed at policy makers and education/service commissioners within the NHS in England and makes recommendations for how pharmacists can play an increasing role in the prevention, early detection, care and support of people with type 2 diabetes.

To improve care for people with type 2 diabetes, the RPS are calling for:

  1. Pharmacists should work in collaboration with other healthcare professionals to play a greater role in prevention and detection services for type 2 Diabetes
  2. Pharmacists should play an active role in optimising medicines, improving the health, wellbeing and safety of people with type 2 diabetes across the NHS
  3. Pharmacists in specialist and generalist roles should be given access to the most up to date education and training to support people with multiple conditions
  4. NHS organisations need to establish and embed the role of consultant pharmacists in diabetes across the NHS should ensure improved outcomes in the management of people with type 2 diabetes, promote collaborative practice, multidisciplinary team working, quality improvement and research.

Full detail at Royal Pharmaceutical Society

See also: Pharmacists must be integrated into diabetes care | RPS press release

Insulin Safety Week: National campaign promotes insulin safety

Diabetes Times | May 2019 | National campaign promotes insulin safety

This week to mark Insulin Safety Week (20-26 May 2019) over 500 diabetes teams predominantly in hospitals from the UK and Ireland  will promote the message of insulin safety. 

According to the results from the latest National Diabetes Inpatient Audit, extrapolated by the Diabetes Times, two in five people with diabetes on insulin (40 per cent) experience an error related to the administration of the drug while in hospital.

In response, the seven-day awareness campaign in an attempt to reduce incidents of insulin errors as part of Insulin Safety Week.

A total of 343 sites, mainly hospitals and GP surgeries, took part in the first-ever national Insulin Safety Week in May 2019, building on interest generated by successful local campaigns across the country in 2017, including in Leicester, Hastings, Eastbourne and Southampton.

Full, unabridged story from Diabetes Times

National diabetes audits

The Healthcare Quality Improvement Partnership has published the results of the following audits relating to diabetes:

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Image source: http://www.hqip.org.uk
  • National Paediatric Diabetes Audit: annual report 2017-18: care processes and outcomes – provides an analysis of data for children and young people with diabetes including information on prevalence of diabetes, diabetes-related outcomes and complications, compliance with health care checks and recommendations for improvements in care
  • National Diabetes Inpatient Audit – measures the quality of diabetes care provided to people with diabetes while they are admitted to hospital.  The results are presented in two reports covering the hospital characteristics survey and serious inpatient harms

Additional links: NHS Digital – National Diabetes Inpatient Audit (NaDIA) – 2018 | NHS Digital National Diabetes Inpatient Audit – Harms, 2018

Additional link: NHS Digital – National Diabetes Foot Care Audit, 2014-2018

Patients on NHS type 2 diabetes prevention programme lose almost 60,000kg between them

NHS England | April 2019 | Patients on NHS type 2 diabetes prevention programme lose almost 60,000kg between them

New figures released by NHS England show that the 17 000 participants of the diabetes prevention programme (DPP), lost on average 3.4 kg. This is more than 1 kg than they were predicted to lose.

The programme  provides advice on dieting, exercise and healthy lifestyle, is being doubled in size over the next few years to treat around 200,000 people annually as part of the NHS Long Term Plan’s renewed focus on prevention.

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The diabetes prevention programme is set to expand further in July this year as wearables and apps will enable patients who cannot attend DPP sessions due to work and family commitments, to participate online.

DPP is designed to stop or delay onset of Type 2 diabetes through a range of personalised lifestyle interventions, including:

  • education on lifestyle choices
  • advice on how to reduce weight through healthier eating
  • bespoke physical activity programmes (Source: NHS England)

Professor Jonathan Valabhji, NHS England national clinical director of diabetes and obesitysaid: “Around two thirds of adults and one third of children are now overweight or obese, driving higher and higher rates of Type 2 diabetes that we are now focusing huge efforts to address, as outlined in the NHS Long Term Plan.

“I’m delighted that our work so far in this area has been producing really positive results. This weight loss is promising – and we hope to help many more of those who are at risk of Type 2 diabetes to not get it in the first place.”

Full story from NHS England 

In the news:

OnMedica Weight loss targets exceeded on NHS type 2 diabetes prevention programme

Type 2 Diabetes screening in community pharmacies could increase early diagnosis

University of East Anglia | March 2019 | Type 2 Diabetes screening in community pharmacies could increase early diagnosis

Research undertaken by the University of East Anglia in conjunction with high street pharmacy Boots, identifies community pharmacies as being well positioned to screen patients for type 2 diabetes.  

Researchers studied the cost effectiveness of a pilot in community pharmacies in Surrey and Leicester; with data collected from 328 participants during a six month period in 2014. The experts found that the cost of each test and the pilot’s identification statistics in patients were similar to those in medical practices for type 2. The team reduced the number of tests needed through a risk screening questionnaire.

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The authors suggest providing a targeted screening service at a community service in an area with suspected high prevalence of type 2 diabetes  could increase the proportion of patients who follow pharmacist advice to visit their GP- which would reduce the cost-effectiveness of the screening service.

Prof David Wright, from UEA’s School of Pharmacy, said: “This study shows that screening though community pharmacies is no more costly or less effective than undertaken through other routes. For such services to be cost-effective however, we also need to intervene in those identified as ‘high risk’ to prevent progression to diabetes.

“This is a natural addition to the diabetes screening process and, with appropriate funding, is something which community pharmacists can effectively do to contribute to the public health agenda.” (Source: University of East Anglia)

Read the full press release at University of East Anglia 

The paper has been published in the journal Pharmacy 

 

Full reference: Wright, D., Little, R., Turner, D., & Thornley, T. |2019| Diabetes Screening Through Community Pharmacies in England: A Cost-Effectiveness Study| Pharmacy| 7| 1| 30.

Abstract

Community pharmacies are commonly used to screen for patients with diabetes. The aim of this paper is to estimate the cost per test and cost per appropriately referred patient from a pharmacy perspective using a one-year decision tree model. One-way sensitivity analysis was performed to estimate the effect of geographical location and patient self-referral rate. Data was used from 164 patients screened and located in an area with average social deprivation and largely white European inhabitants and 172 patients in an area with higher social deprivation (lower than average ability to access society’s resources) and a mixed ethnicity population in England. The diabetes screening consisted of initial risk assessment via questionnaire followed by HbA1c test for those identified as high risk. The cost per person screened was estimated as £28.65. The cost per appropriately referred patient with type 2 diabetes was estimated to range from £7638 to £11,297 in deprived mixed ethnicity and non-deprived areas respectively. This increased to £12,730 and £18,828, respectively, if only 60% of patients referred chose to inform their general practitioner (GP). The cost per test and identification rates through community pharmacies was similar to that reported through medical practices. Locating services in areas of suspected greater diabetes prevalence and increasing the proportion of patients who follow pharmacist advice to attend their medical practice improves cost-effectiveness.

The article can also be accessed in full here 

Transforming elective care services diabetes

NHS England | January 2019 | Transforming elective care services diabetes

NHS England have created Transforming elective care services diabetes– a handbook to support the improvement of local health and care systems for diabetes elective care services.

This handbook sets the national context and challenges facing elective care services in England. It considers the national diabetes challenge

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Image source: england.nhs.uk/wp-content

The handbook includes:

  • Opportunities for improvement transforming outpatients
  • Opportunities for improvement shared decision making and self- management support

Transforming elective care services diabetes

Over 26,000 diabetes-related lower limb amputations in the last three years

Diabetes UK | December 2018 | 26,378 diabetes-related lower limb amputations in the last three years

New analysis from Diabetes UK  shows there were 26,378 lower limb amputations related to diabetes in England from 2014 to 2017, an increase of almost one- fifth  (19.4%) from 2010-2013.

The analysis reveals that here has been a significant rise in minor lower limb amputations (26.5%), defined as below the ankle, and a more gradual increase in the number of major lower limb amputations (4.1%), defined as below the knee.

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Head of Care at Diabetes UK, Dan Howarth said:

“The shocking number of lower limb amputations related to diabetes grows year on year. An amputation, regardless of whether it’s defined as minor or major, is devastating and life-changing. A minor amputation can still involve losing a whole foot.

“To reduce the number of amputations related to diabetes, we are calling on NHS England to maintain the Diabetes Transformation Fund beyond 2019. Many diabetes amputations are avoidable, but the quality of footcare for people living with diabetes varies significantly across England. Transformation funding since 2017 is working and will help to reduce these variations, but much work still needs to be done.” (Source: Diabetes UK)

Read the full release from Diabetes UK

In the news:

Guardian Record 169 UK patients a week get diabetes-related amputations