Diabetes UK Annual Professional Conference 2008: Body, mind and science

Junior doctors need more training in inpatient diabetes care
Questionnaire-based data presented at the conference demonstrated that junior doctors’ knowledge and confidence in managing hospital inpatients with diabetes was found to be poor. The doctors were asked to complete a questionnaire that included three multiple-choice scenarios, and felt confident in managing common scenarios. However, the doctors were unable to give correct answers when challenged.

The three scenarios were: managing an inpatient with diabetic ketoacidosis (DKA); managing a morning hypoglycaemic episode in an inpatient with type 1 diabetes; managing a raised blood glucose level at 2am in an inpatient with type 2 diabetes.

Junior doctors gave the most wrong answers for the hypoglycaemia scenario which they claimed to feel most confident about, and many omitted insulin.

Medical students and junior doctors therefore require more structured teaching in diabetes, particularly relating to everyday practical situations. Diabetes care could be improved by including guidelines for the management of common situations on monitoring charts.

In addition to this, prior to the Diabetes UK Conference, the NHS Institute for Innovation and Improvement (NHS Institute) released a statement highlighting the poor level of care experienced by diabetes inpatients in some hospitals. Jonathan Thow, a consultant physician in diabetes and endocrinology said: ‘Research shows that [people with diabetes’] experience of inpatient care is, at best, inconsistent across the NHS, and at worst, very poor in some areas’.

However there are cases of excellent practice in some hospitals and the NHS Institute will be releasing some products based on these cases in May 2008, to help to improve standards of care in all hospitals.

‘Diabetes UK Measure Up’ campaign arrives in London
In partnership with NHS London, Diabetes UK’s Measure Up campaign aims to get people in London measuring their waist to see if they are at risk of type 2 diabetes, as having a large waist means you are up to twelve times more likely to develop diabetes.

DESMOND receives further funding to allow rolling out of new modules
An educational grant has provided more locations in which to train educators so that they can deliver all three DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) programmes. A pharmaceutical company provided the funding allowing additional places on the award-winning DESMOND training and ongoing quality development programme.

DESMOND has also launched a new module. The new ‘Foundation’ module is aimed at people with established type 2 diabetes, and will complement the existing module for those newly diagnosed. A new version of the ‘Newly Diagnosed’ module will also be released this Spring and will be tailored to the culturally-specific needs of the South Asian community. The prevalence of type 2 diabetes is five times higher in the South Asian community compared to that of the Caucasian population.

Dr Marian Carey (National Director, DESMOND Programme) stated that ‘We hope that our new modules will give primary care trusts the means to provide the knowledge and skills that enable people with diabetes to engage in the ongoing learning process that is so vital to living with this chronic condition’.

DAFNE may be able to reduce duration and frequency of hospital admissions
Attendance on a DAFNE (Dose Adjustment For Normal Eating) course has been shown to improve long-term glycaemic control in people with type 1 diabetes. There was a 59% reduction in the number of admissions into hospital and a 63% reduction in length-of-stay after attending a DAFNE course. Data were collected between June 2002 and May 2004 from 153 people with type 1 diabetes.

New education tool: Conversation Maps for use with patients launched
An innovative new tool, designed to help people with diabetes effectively self-manage their condition and achieve better health outcomes was launched at Diabetes UK’s Annual Professional Conference.

The Diabetes Conversation MapTM programme was created by Healthyi (www.healthyi.com) in partnership with Diabetes UK, and is sponsored by Lilly.

The programme consists of four 3’x5’ tabletop illustrations, addressing different aspects of living with diabetes. Healthcare professionals trained to facilitate the Conversation MapTM programme use the tabletop visuals to guide small groups of three to ten people with diabetes through an illustrative journey encountering images, questions and facts, encouraging lively discussion and participation.

‘Conversation MapTM enables a discussion that goes both ways, instead of a didactic, one-way information flow. People walk away from each session feeling so much more empowered about taking control of their diabetes than if they’d simply attended a class’ said Joanne Hamilton, after using the Conversation Map in Canada for 2 years.

New National Clinical Director for Diabetes is announced
Dr Rowan Hillson MBE has been appointed as the new National Clinical Director for Diabetes. Dr Hillson is a consultant Physician and Diabetologist at the Hillington Hospital, London. Douglas Smallwood, Chief Executive of Diabetes UK, said: ‘Although progress has been made since the national standards for diabetes care were set, we still have a long way to go in providing the best care possible for everyone with diabetes – and Dr Hillson’s contribution to this will be vital’.

Secretions from the South American Paradoxical frog could treat diabetes
A frog’s skin secretions could be used to treat type 2 diabetes. Scientists have been studying the Paradoxical frog, Pseudis paradoxa, from South America and have found that Pseudin-2, a peptide protecting the frog from infection found in it’s skin secretions, stimulates insulin release. A synthetic version of the peptide has been tested and results show that it could be used to produce a drug that stimulates the production of insulin in people with type 2 diabetes.

The Paradoxical frog shrinks with age: as tadpoles they can reach up to 27cm in length, but as frogs they are only about 4cm long.

Diabetes Specialist Nurses could save the NHS millions
Diabetes Specialist Nurses could reduce the NHS deficit (£623 million) by almost £100 million.

A 12-month trial conducted at the University Hospitals of Leicester (UHL) NHS Trust found that 42% of people with diabetes admitted to the hospital were discharged within 24 hours after being seen by a Diabetes Specialist Nurse (DSN).

DSNs visted the Emergency Medical Unit, Monday to Friday, and proactively identified people with diabetes. A total of 111 people were reviewed, of whom 47 were discharged within 24 hours – the average stay in hospital for a person with diabetes is normally 11 days.

Douglas Smallwood, Chief Executive of Diabetes UK, said ‘Diabetes UK estimates that people with diabetes spend 1.1million days in hospital a year. Almost 100 million pounds could be saved if these hospital days were reduced by 42 per cent.’ Helen Atkins, DSN at the University Hospitals of Leicester NHS Trust, said: ‘After the positive results of the evaluation we have now introduced the same service in accident and emergency and other medical admissions units within UHL Trust.’

Survey uncovers consultant diabetologists’ frustrations
The results from a survey conducted by ABCD and Diabetes UK revealed that consultant diabetologists across the UK are concerned about inadequate staffing levels, budget cuts, low morale and heavy workloads.

Consultants are also concerned that the provision of psychological support, education and dietetic advice for people with diabetes is not up to standards. Although the report did also highlight that improvements have been made since 2000, including improved access to laboratory tests, better provision of joint ante-natal diabetes services and joint paediatric and adult specialist diabetes services.

Peter Wincour, of ABCD and Consultant Physician at Queen Elizabeth II Hospital in Welwyn, who co-ordinated the study, said: ‘As the number of people diagnosed with diabetes continues to rise, it is essential that the commissioning and designing of those services are constantly developed with the best interest of the individual patient in mind.’

Women with diabetes more likely to have a stillborn baby
Research looking at 130 pregnancies in Leicester of women with type 1 diabetes between 1999 and 2000 showed that 3.9% resulted in stillbirth. This compares with 0.55% of stillbirth in all women. The research also found that Caesarean sections and congenital malformations were more than double that of women without diabetes.