During the early months of 2022, a team of prospective and qualified nurses set out to improve the identification, lifestyle and outcomes of their patients who were at risk of developing type 2 diabetes. A diabetes prevention event was conceptualised after the team noticed that the Netherfield House Surgery in Seghill, Northumberland, reviewed 178 fewer patients at risk of type 2 diabetes in 2021 than during the pre-pandemic year of 2019. This 79% reduction in the monitoring of those considered to be at the greatest risk of developing type 2 diabetes concerned us, as we felt that it was insufficient and that, as a consequence, new diagnoses may have been missed.
We decided to hold a morning event aimed at increasing monitoring for this “at risk” patient population, and to provide additional support and information to improve their experience and future outcomes. To recruit for it, we sent invitations by text message to all practice patients identified through the coding system as being at risk of developing type 2 diabetes.
The event consisted of checks on blood pressure, height and weight, and HbA1c, while also providing attendees with information on diabetes prevention. This included a range of home-made recipes that we created that were low in sugar and good for health, to aid better glycaemic control through diet. The cost of each recipe was also detailed as the team felt that money strongly impacts the ability to eat healthily; our recipes aimed to be budget friendly.
Using interactive learning methods, we provided a range of quizzes to inform people of facts and information about type 2 diabetes. There was also information on family-friendly exercise and activities that do not always involve the expense of going to the gym and are, therefore, more likely to be adopted by our specific patient population. When creating these information sheets, we wanted to work around the perceived barriers to healthy eating and exercise as much as possible. They were provided as handouts to avoid bombarding people with too much information on the day, and to provide concise reference material for people interested in type 2 diabetes prevention.
The nursing team founding this event recognised that type 2 diabetes is not a condition that can be managed and identified solely from a nursing perspective. We felt, therefore, that it was important to include members of the multidisciplinary team to broaden the number of perspectives and provide additional insight for both staff and patients. Members of the team involved were the practice manager, practice nurses, GPs, medical students (from Newcastle University), WW team (formerly known as Weight Watchers), pharmacists and additional student nurses.
The event proved to be a huge success and received an array of positive feedback from people who attended. The student nurses led the follow-up and contacted every attendee to inform them of their results. This provided the opportunity to open discussions on an individual level to clarify information and to answer questions stemming from the event.
We also informed the patients that they could be referred to the WW team if they met the requirements. We found this was helpful, as it completed a full cycle with the patient and ensured that they had all the information they needed, their questions were answered and they felt supported through their journey. Often, we were able to tell people the good news that their HbA1c was dropping and to encourage them to continue with their successful lifestyle changes. The event identified two people whose HbA1c had risen and who were subsequently diagnosed with type 2 diabetes, and confirmed that 25 attendees were still at risk of developing the condition.
The event also identified some coexisting health issues. The student nurses were confident assessing patients during the diabetes prevention day using skills and knowledge gained from their previous clinics, such as the student nurse-led blood pressure clinic. During the day, they helped to newly identify 21 people who had high blood pressure, which prompted discussion with the GPs, pharmacy team and those affected to help target control.
The results of the diabetes prevention event have been overwhelmingly positive. We not only helped the patients we saw that morning, but also spread the word about how healthcare professionals and patients can help to reduce the risk of the condition progressing. We hoped that the information given to the patients would encourage them to modify their lifestyle factors and reduce their risk of type 2 diabetes.
The success of this event helps to confirm that there are steps that primary care can take to enhance the care of people at risk of developing type 2 diabetes. Patient feedback was positive, and the additional screening and health promotion provided through the event has improved care.
It also highlights the skill set that nursing students bring to the profession, emphasises the difference they can make, and how they can use their knowledge and management skills to create a health promotion event to help patients within a disease process, such as type 2 diabetes.
Following our initiative to promote lifestyle changes and health reviews in the Seghill community, and the wider Nurses on Tour project that it inspired in the county, the team was delighted to be named as finalists in the Royal College of Nursing’s Nursing Awards. Events like ours can raise the profile of primary care and remind us what it can achieve through teamwork and innovation.
The author would like to acknowledge the hard work of the team – Rebecca Stuart, Mia Easthope and Sumaiya Miah – who made this event possible; Netherfield House Surgery in Seghill that inspired us to develop an event to help their community and who supported us throughout; and, finally, Northumbria University for supporting the event.