a new pathway for diabetes? dr chris walton · pdf filepreventing progression of ckd ......
TRANSCRIPT
Dr Chris Walton
A new pathway for diabetes
Disclosures
Educational Sponsorship last three years
Abbott Boehringer Ingelheim Lilly MSD NovoNordisk
Sanofi
No boards or speaker fees
THE PRACTICE NURSE
National Diabetes Audit 2012-13
National Diabetes Audit 2012-13
Diabetes Sample Service Specification
httpwwwcommissioningassemblynhsukpgcv
_contentcontentview134433
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Disclosures
Educational Sponsorship last three years
Abbott Boehringer Ingelheim Lilly MSD NovoNordisk
Sanofi
No boards or speaker fees
THE PRACTICE NURSE
National Diabetes Audit 2012-13
National Diabetes Audit 2012-13
Diabetes Sample Service Specification
httpwwwcommissioningassemblynhsukpgcv
_contentcontentview134433
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
THE PRACTICE NURSE
National Diabetes Audit 2012-13
National Diabetes Audit 2012-13
Diabetes Sample Service Specification
httpwwwcommissioningassemblynhsukpgcv
_contentcontentview134433
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Diabetes Audit 2012-13
National Diabetes Audit 2012-13
Diabetes Sample Service Specification
httpwwwcommissioningassemblynhsukpgcv
_contentcontentview134433
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Diabetes Audit 2012-13
Diabetes Sample Service Specification
httpwwwcommissioningassemblynhsukpgcv
_contentcontentview134433
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Diabetes Sample Service Specification
httpwwwcommissioningassemblynhsukpgcv
_contentcontentview134433
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Pillars of Integration
Integrated IT systems
Robust Shared Clinical Governance
Care Planning
Aligned finances and responsibility
Clinical Engagement and Partnership
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
The complicated NHS in England
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Senates and Strategic Clinical Networks
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
A Foot Attack
an ulcer blister or break in the skin of the foot
inflammation or swelling of any part of the foot or any sign of infection
unexplained pain in the foot
fracture or dislocation in the foot with no preceding history of significant trauma
gangrene of all or part of the foot
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Key to improving foot outcomes
Ensuring resources in place
Getting people at risk identified
Everyone understanding what should happen in event of a lsquofoot
attackrsquo
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Preventing progression of CKD
1) Ensuring appropriate levels of BP control
2)Medication reviews to stop potentially nephrotoxic medication eg
NSAIDrsquos
3)Ensuring lsquosick day advicersquo includes advice about temporarily
stopping diuretics ACE inhibitors when appropriate to avoid
acute on chronic kidney injury
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Preventing progression of CKD
Intensified multifactorial intervention and cardiovascular
outcome in type 2 diabetes the Steno-2 study
Pedersen O1 Gaede P
lsquoan intensified and goal-oriented multipronged approach to the treatment of type 2
diabetes reduces cardiovascular events as well as nephropathy retinopathy and
autonomic neuropathy by about halfrsquo
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Preventing progression of CKD
December 31 2013
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Doesnt Benefit Anyone
Paul S Mueller MD MPH FACP
Several new randomized trials and a meta-analysis all showed the same thing
No benefit and possible harm
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Preventing progression of CKD
Tracking eGFR
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Prevention of diabetes
Likely to be a major national focus linked to tackling obesity
epidemic-with funding
Employers targeted
People with high risk of diabetes (health checks)
Merseyside Impaired Glucose Regulation Pathway
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Strategic Clinical Network
Priorities for Diabetes
Footcare -reducing amputations
Preventing progression of CKD
Prevention of diabetes
Improving performance of 9 care processes
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Individual SCN initiatives
Thames Valley SCN
Targeting improvement in care process performance through
care planning
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
3 Dimensions of Care For Diabetes
3DFD
Annual saving of pound102k per 100 patients per year based on the
reduction in HbA1c from the first pilot
The service delivers
Multi-disciplinary patient-centred care which integrates medical
psychological and social care to address health inequalities
Improved diabetes control and reduction of complications by addressing
psychological and social barriers to diabetes self-management
Improvements in unscheduled care decreased AampE attendances and
hospital admissions
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Commissioning Recommendations for
Psychological Support in Diabetes
httpwwwslcsnnhsukscnmental-healthmh-physical-
care-diabetes-082014pdf
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Newsham Shine Project
Transitional and Young Adults
About the project
The Newham Shine 2011 project involved replacing routine follow-up outpatient appointments that
donrsquot require physical examination with web-based consultations These consultations were offered
to all patients attending the transitional and young adult service and for all patients under a
consultant in the general diabetes clinic
A pilot was carried out in February 2010 which demonstrated high patient and staff satisfaction
with the potential not only to improve access but also to encourage a more positive approach to
care and self-management
The project had a significant impact on patients particularly those who have difficulty accessing care
due to their busy lifestyles or multiple commitments and those with limited mobility or who are
housebound For staff it encouraged more focused consultations and better use of face-to-face time
for clinical activities
It was anticipated that the project would result in a reduction in the cost per outpatient contact as
the rate of non-attendance reduces overhead costs will be reduced and it is expected that there will
be a reduction in emergency attendance over time The team hoped that there would also be
improved health outcomes and a reduction in demand for other routine services
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Yorkshire amp
The Humber
Diabetes SCN
17th Octob
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Yorkshire and Humber SCN
Diabetes Workstreams
Task amp Finish Groups
Footcare
Supported Self Care
Clinical Expert Group
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Diabetes Audit
Type 2 DM 2011-12
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
National Diabetes Audit
Type I DM 2011-12
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Diabetes In Care Homes-Key Findings
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Diabetes in Older People
Hypoglycaemia BGlt 4 mmolL
very common
under recognized in older people
can cause falls cognitive impairment and hospital admission
increased in individuals with
polypharmacy
cognitive impairment
malnourishment
patients recently discharged from hospital
patients who reside in a nursing home
What should target Hbaic be in a frail older person with diabetes
lt60 lt 65 lt 70
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Diabetes in Older People
IDF Guideline
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Diabetes In Care Homes-Key Findings
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Improving Diabetes Care in
Care Homes
Held sub regional event for care Home managers and Staff
Workshop on practical steps to Improve Care
Event evaluated very well
Catalyst for work programme in East Yorkshire
Local Authority CCG and Acute Trust collaborating with an
education budget
2 further events scheduled in other parts of the region as a
result of success of first event
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
Lengths of stay
Hull and East Yorkshire Hospitals NHS Trust
Diabetes Inpatient Team (DIT)
DIT expanded amp Virtual Diabetes Hospital piloted
