In January 2017, the Chair of the Children and Young People’s North East and North Cumbria Diabetes Network presented a cumulative mean HbA1c chart, which showed the HbA1c outcomes in the various diabetes teams across the network. The shining star that day was South Tyneside NHS Trust, which had seen an amazing improvement of almost 10 mmol/mol over a period of only 24 months.
Rather than celebrate their success and move on, the team at South Tyneside reviewed their service to identify how the improvement had happened. The Best Practice Tariff (BPT), investment in staffing, additional contacts with children and young people and their families, the introduction of a high HbA1c pathway, increased use of insulin pumps and structured education programmes were all considered to have contributed to the improvement, but all teams in the network could confirm these factors were relevant to them too. What were South Tyneside doing differently?
Home uploading
The lightbulb moment came when the paediatric diabetes specialist nurses (PDSNs), with support from their clinical team, slowly began introducing their families to the idea of improved self-management using a home uploading facility provided by Diasend (now Glooko). Families were already familiar with uploading their meters and pumps to Diasend while in clinic, but enabling them to upload at home gave the team the opportunity to review the data remotely and teach self-management skills. It also gave families the confidence to make changes themselves in between clinics. With a small caseload of less than 60 patients, the team were able to introduce home uploading to the whole clinic very quickly, and they are able to respond to downloads in a structured manner.
The advantages speak for themselves:
- Increased contact with families provides increased support and helps achievement of BPT criteria.
- Convenient for families to upload and PDSNs to review.
- Increased patient involvement/motivation; young people engage with using computers/tablets to upload their data.
- Effective use of PDSN time.
- Accurate/meaningful information (no more made-up diaries or difficult phone calls).
- Easy to see total daily doses; this led to further education regarding insulin sensitivity factors and empowered patients to make changes independently.
- Clinics are quicker (less time spent reviewing uploads), more time is available for education or dietitian/psychologist support, and more appointments can be offered (six per year).
- Patients report a more positive clinic experience and less confrontation.
- Ability to configure target ranges to achieve tighter control.
- Uploading is an additional resource to use if the child/young person is on the high HbA1c pathway.
- Better cover when colleagues are on annual leave.
- Ability to filter to show uploads sent in the past 2 days, which encourages a structured way of working.
- Uploads are available on any computer/tablet: useful if staff are on call and for multidisciplinary team members to access (e.g. dietitians when teaching carbohydrate counting).
Evaluation
The South Tyneside team were keen to conclude that the introduction of home uploading was the reason for their fantastic results when compared with neighbouring teams, but some convincing was still needed! Therefore, they compared their data with and without home uploading, as in Table 1.
In the author’s opinion, these results really do speak for themselves!
