Diabetes Specialist Research Articles

Experiences and actions related to living with type 1 diabetes during the COVID-19 pandemic in Norway: a qualitative study conducted during July to December 2020

ObjectivesThe aim of this study was to describe the experiences of adults with type 1 diabetes (T1DM) during the COVID-19 pandemic in Norway, and what actions they took to cope...

IDF21-0049 ACT NOW a new diabetes foot educational and risk assessment tool for people with diabetes and health care professionals

Background: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and health care professionals (HCP) may be accused of medical negligence. Aim: Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Method: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a person with diabetes and recommendations were made. Results: An acronym ACT NOW has been devised to act as an educational tool ACT NOW stands for Accident (recent trauma to foot) Change in colour or shape, Temperature change -hot or cold, New pain, Oozing and Wound. The acronym was devised firstly, to help PwD and HCPs recognise the warning signs of foot complications, leading to potential amputation, and secondly, to trigger early and prompt referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the COVID 19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW tool was also created consisting of the acronym and a a checklist which prompts the PwD, their carers and HCPs to enquire and document the ACT NOW! symptoms or signs and to take possible further information such as a digital photo. The checklist can then be used as a document to facilitate referral to specialist care. Alternatively, the check list can be used when PwDs present for routine assessment with their HCPs. The ACT NOW tool has been disseminated through digital and traditional media and endorsement granted from many organisations, including the IDF. Discussion: Foot ulcers are highly susceptible to infection which can spread rapidly, causing overwhelming tissue destruction or gangrene, necessitating major amputation. The progression from an initial ‘scratch’ to gangrene can take as little as 48 hours. A lack of knowledge and education can lead to a lack of urgency among PwD, carers and HCPs, who may not recognise that they have a foot related problem requiring urgent referral or care interventions. If there are difficulties in accessing a HCP appointment, there is a risk of critical delay in PwD receiving appropriate assessment and treatment. ACT NOW is designed to promote timely referral and save limbs. iDEAL seeks to reduce amputations by 50% in 5 years by encouraging people to use ACT NOW. Prompt assessment and early referral can help reduce this unnecessary suffering. ACT NOW also seeks to reduce stigma often experienced by PwD regarding complications and remove any blame or shame associated with diabetes complications. These changes can be created through encouraging and enabling an environment of education, knowledge and trust using language that enables PwD.

IDF21-0641 Diabetes Mellitus and periodontal health: identifying factors that influence implementation of best practice guidance

Background: Evidence suggests the existence of a two-way relationship between periodontal (gum) disease and diabetes mellitus. There are several guidance documents available internationally for both medical and dental practitioners, which outline the management of diabetic patients with regards to their oral health. These documents advise medical practitioners that they should discuss that sub-optimal glycaemic control can worsen periodontal health and treatment outcomes, whilst poor periodontal health can lead to poorer glycaemic control. Guidance also states that medical practitioners should refer newly diagnosed diabetic patients to their dentist for a periodontal assessment and advise regular dental visits. Previous research in England has demonstrated that despite available guidance documents, medical professionals do not routinely inform their patients about the link between these conditions. There was also found to be a lack of inter-disciplinary communication between medical and dental professions. There was a need to corroborate this evidence, by investigating current practice within a Scotland wide cohort and on a larger scale. Our study explored current practice, knowledge and beliefs with regards to health practitioners’ communication with patients regarding diabetes and periodontal disease as well as exploring the barriers and facilitators to implementation of the advice. Methods: A cross-sectional observational study was undertaken. Virtual focus groups with medical professionals were carried out to ascertain whether and how the link between diabetes and periodontal disease was being discussed with patients and to identify facilitators and barriers to these discussions. An online questionnaire was then developed, based upon data collected from the focus groups. This was underpinned by the Theoretical Domains Framework, a behaviour change tool that can be used to understand implementation behaviours. The questionnaire was distributed via local networks to Endocrinology consultants, registrars, GPs, diabetes specialist nurses, practice nurses and healthcare assistants involved in the care of diabetic patients across Scotland. Qualitative data was analysed using qualitative content analysis. Quantitative data was analysed using IBM SPSS Statistics v24, and subjected to frequencies calculations, correlations, analysis of variance and regression. Results/Discussion: Results from the focus groups revealed a lack of knowledge and anecdotal evidence that the desired behaviours were not being carried out by medical professionals. There were 131 responses in total to the questionnaire. Seventy-five percent of the responses were from GPs and nurses, and 88% of the respondents worked in primary care. Results highlighted that medical practitioners rarely discussed the bidirectional relationship of diabetes and periodontal disease with patients. In addition, results demonstrated the lack of inter-disciplinary communication between the medical and dental professions. Lack of knowledge, lack of guidance, belief that this is not within the remit of the profession, time/administration pressures and patient influences were amongst some of the main barriers identified from the quantitative and qualitative data. Conclusion: Identification of barriers and facilitators can allow for the development of interventions to support medical practitioners in adhering to best practice guidance. The next stages of this project will be to design, implement and evaluate these interventions with the hope of improving care outcomes for patients with diabetes.

Health-Care Disparities in the Use of Diabetes Technologies in the UK

Health inequalities have been a longstanding challenge for decades with widening disparities in recent years. Much focus is rightly placed on inequalities based on race/ethnicity, but it is clear that racial disparities and socioeconomic deprivation are interlinked. The connection between systematic and personal bias against individuals from the most deprived groups, irrespective of ethnicity, clearly exists. Socioeconomic deprivation appears to be an influential factor driving health disparities, with implicit bias directed against individuals living in poverty. This is reflected in access to diabetes technologies such as insulin pump therapy, continuous glucose monitoring systems, and automated insulin delivery where those from ethnic minority backgrounds and those in areas of highest deprivation are least able to access or benefit from such technological advancements. Inequalities are further reinforced by government cuts in spending. Between 2009 and 2020, net expenditure per person in local authorities in the 10% most deprived areas fell by 31% compared with a 16% decrease in the least deprived areas. These regressive cuts included a failure of health-care spending to rise in accord with historical patterns. Compounding the challenges were cuts to public health funding and reductions in welfare payments to families most in need. These widening health inequalities are unacceptable and unfair within a national health system where all individuals are entitled to the same level of care. Improved access to specialist diabetes care teams and to life-enhancing technologies could improve the health of all people with diabetes and reduce its human and financial cost.

Sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes: Barriers and solutions for improving uptake in routine clinical practice.

Recent advances in type 2 diabetes (T2D) research have highlighted the benefits of sodium‐glucose co‐transporter‐2 (SGLT‐2) inhibitors, including cardiovascular and renal protection. However, uptake rates of these drugs remain low in patients with T2D, particularly in subpopulations most likely to benefit from them. This review considers the potential barriers to prescribing SGLT‐2 inhibitors in T2D in clinical practice and outlines potential multidisciplinary recommendations to overcome these barriers. Safety concerns and a lack of clarity in and divergence of guidelines around the introduction of SGLT‐2 inhibitors into treatment regimens may represent a barrier to uptake from the clinicians' perspective, including a general lack of understanding of the benefits associated with SGLT‐2 inhibitors. Patient characteristics, such as socioeconomic status, may influence uptake because of the cost of SGLT‐2 inhibitors, especially in the United States, where health insurance coverage could be a concern. SGLT‐2 inhibitor prescription rates vary between clinical specialty (endocrinology, primary care, cardiology, and nephrology) and country, with cardiologists the lowest prescribers, and endocrinologists the highest. Primary care practitioners may experience more challenges in following SGLT‐2 inhibitor‐related guidelines than diabetes specialists as there may be fewer opportunities for education on how this drug class improves cardiovascular and renal outcomes in patients with T2D. Uptake rates appear to vary between countries because of differences in guidelines and health insurance systems. The amendment of SGLT‐2 inhibitor‐related guidelines for more multidisciplinary use and the implementation of patient and clinician education may encourage uptake of these drugs, potentially improving long‐term health outcomes among patients with T2D.

Randomised controlled trial of an innovative hypoglycaemia pathway for self-care at home and admission avoidance: a partnership approach with a regional ambulance trust.

Hypoglycaemia is a common and potentially life-threatening condition in people with diabetes, commonly caused by medications such as insulin. Hypoglycaemic events often require in-patient treatment and/or follow-up with a diabetes specialist nurse (DSN) or GP to make adjustments to medication. This referral pathway commonly relies on patient self-referral to primary care, and as a result many patients are not actively followed up and go on to experience repeat hypoglycaemic events. Randomised controlled trial in partnership with East Midlands Ambulance Service NHS Trust. People with diabetes calling out an ambulance for a severe hypoglycaemic episode and meeting the eligibility criteria were randomised to either a novel DSN-led pathway or to their general practice for routine follow-up. Primary outcome was proportion of participants with a documented consultation with a healthcare professional to discuss the management of their diabetes within 28 days of call-out. 162 people were randomised to one of the pathways (73 DSN arm, 89 GP arm) with 81 (50%, 35 DSN, 46 GP) providing full consent to be followed up. Due to lower than anticipated randomisation and consent rates, the recruitment target was not met. In the 81 participants who provided full consent, there were higher rates of consultation following the call-out when referred to a DSN compared to primary care (90% vs. 65%). Of the 81 participants, 26 (32%) had a second call-out within 12 months. Consultation rates following the call-out were high in the DSN-led arm, but there was insufficient power to complete the planned comparative analysis. The study highlighted the difficulty in recruitment and delivery of research in pre-hospital emergency care. Further work is needed to provide more feasible study designs and consent procedures balancing demands on ambulance staff time with the need for robust well-designed evaluation of referral pathways.

Key Factors Relevant for Healthcare Decisions of Patients with Type 1 and Type 2 Diabetes in Secondary Care According to Healthcare Professionals.

PurposeUnderstanding which factors are important for healthcare decisions of patients with diabetes in clinical practice is important to personalise diabetes care strategies and tailor care plans to the individual. The main drivers for these healthcare decisions remain unclear. This study assessed which key factors are relevant for healthcare decisions during clinical consultations for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM), according to healthcare professionals.Materials and MethodsAnnual diabetes reviews were performed as part of a trial assessing the impact of a consultation model facilitating person-centred diabetes care in six hospital outpatient clinics. After each consultation, we asked healthcare professionals to choose a maximum of three out of 20 factors that were most relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year. Factors were characterised as either person or disease-related. Percentages reflect the number of annual diabetes reviews in which the key factor was reported.ResultsSeventeen physicians and eight diabetes specialist nurses reported the key factors relevant for healthcare decisions in 285 annual diabetes reviews (T1DM n = 119, T2DM n = 166). Healthcare professionals most often reported quality of life (31.9%), motivation (27.0%) and diabetes self-management (25.6%), and to a lesser extent glycaemic control (24.2%), to be important for decisions about treatment goals. For decisions about the professional support needed during the upcoming year patient’s preferences (33.7%), diabetes self-management (33.3%), quality of life (27.0%) and motivation (25.6%) were most often considered relevant by healthcare professionals.ConclusionAccording to healthcare professionals, person-related factors such as quality of life, diabetes self-management and motivation are predominantly relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year.

Health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes in New Zealand.

This study aimed to investigate New Zealand health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes. Semi-structured interviews were conducted remotely with health professionals; sessions were recorded and transcribed. Core themes were extracted using inductive thematic analysis using a framework method. Twenty-seven health professionals were interviewed (13 diabetes dietitians, 8 specialist diabetes midwives, 2 community midwives, 1 antenatal clinic midwife, 1 obstetrician and 2 endocrinologists). Themes were organised into three central domains: (a) Social and cultural barriers, (b) Service provision and (c) Nutrition advice. Enabling themes included professional collaboration, innovation and creating trusting and supportive environments. Key barriers identified included accessibility, cultural barriers, overwhelmed service, fragmentation and conflicting information and nutrition resource gaps. Findings highlight foremost a deficit in primary antenatal nutrition advice that may play a significant role in the fragmentation identified. Investment in community-inclusive services providing antenatal nutrition and diabetes education appears critical to overcome barriers associated with misinformation and poor outcomes. Pathways to include nutrition education from various primary care health providers should be investigated to ease the burden from specialist gestational diabetes clinicians and allow effective delegation of dietetic resources. Revision of current nutrition guidelines for the management of gestational diabetes in New Zealand is needed to facilitate consistent messaging and standards of care.

Aus Sicht der Diabetespraxis: erwachsen werden mit Typ-1-Diabetes

Junge Erwachsene mit Typ-1-Diabetes tragen die Verantwortung für ihre Diabetestherapie weitgehend selbst, gleichzeitig genießen sie neu gewonnene Freiheiten und sind eher risikobereit. Die eigene Wohnung, Partnerschaft, Studium, Beruf und weitere Entwicklungsaufgaben stellen hohe Anforderungen. Diese sind oft schwer mit einer qualifizierten Diabetestherapie vereinbar. Nach der langjährigen persönlichen Bindung an das Team einer Kinderklinik ist der Wechsel in eine internistische Diabetesschwerpunktpraxis nicht immer reibungslos. Individuelle psychische Belastungen und ein unzureichendes Diabetesmanagement verstärken sich dabei gegenseitig. Diabetes verkörpert in diesem Lebensabschnitt genau das Gegenteil von all dem, was altersgemäß ist. Er erfordert einen strukturierten Tagesablauf, disziplinierte Ernährung, regelmäßige Arztbesuche und vorausschauendes Denken und Handeln. Die Analyse der CGM-Daten (CGM: kontinuierliche Glukosemessung [„continuous glucose monitoring“]) in der Diabetespraxis erlaubt detaillierte Einblicke in den persönlichen Alltag, die mit Scham- und Schuldgefühlen verbunden sein können. Ziel der Langzeitbehandlung ist es, alle diese Aspekte – aktuelle Lebensqualität, persönliche Ziele, Vermeidung akuter Diabeteskomplikationen und Prävention langfristiger kardiovaskulärer Folgekomplikationen – zu beachten und daraus partizipativ ein individuelles Behandlungskonzept zu entwickeln. Die wichtigste Aufgabe der Diabetespraxis ist dabei, junge Menschen auf ihrem individuellen Weg zu unterstützen, ihre Stärken anzuerkennen und sie durch Erfolge zu motivieren.

Clinical practice guidelines for management of hyperglycaemia in adults with diabetic kidney disease.

A significant percentage of people with diabetes develop chronic kidney disease and diabetes is also a leading cause of end-stage kidney disease (ESKD). The term diabetic kidney disease (DKD) includes both diabetic nephropathy (DN) and diabetes mellitus and chronic kidney disease (DM CKD). DKD is associated with high morbidity and mortality, which are predominantly related to cardiovascular disease. Hyperglycaemia is a modifiable risk factor for cardiovascular complications and progression of DKD. Recent clinical trials of people with DKD have demonstrated improvement in clinical outcomes with sodium glucose co-transporter-2 (SGLT-2) inhibitors. SGLT-2 inhibitors have significantly reduced progression of DKD and onset of ESKD and these reno-protective effects are independent of glucose lowering. At the time of this update Canagliflozin and Dapagliflozin have been approved for delaying the progression of DKD. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have undertaken a literature review and critical appraisal of the available evidence to inform clinical practice guidelines for management of hyperglycaemia in adults with DKD. This 2021guidance is for the variety of clinicians who treat people with DKD, including GPs and specialists in diabetes, cardiology and nephrology.

Clinical practice guidelines for management of hyperglycaemia in adults with diabetic kidney disease

A significant percentage of people with diabetes develop chronic kidney disease and diabetes is also a leading cause of end-stage kidney disease (ESKD). The term diabetic kidney disease (DKD) includes both diabetic nephropathy (DN) and diabetes mellitus and chronic kidney disease (DM CKD). DKD is associated with high morbidity and mortality, which are predominantly related to cardiovascular disease. Hyperglycaemia is a modifiable risk factor for cardiovascular complications and progression of DKD. Recent clinical trials of people with DKD have demonstrated improvement in clinical outcomes with sodium glucose co-transporter-2 (SGLT-2) inhibitors. SGLT-2 inhibitors have significantly reduced progression of DKD and onset of ESKD and these reno-protective effects are independent of glucose lowering. At the time of this update Canagliflozin and Dapagliflozin have been approved for delaying the progression of DKD. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have undertaken a literature review and critical appraisal of the available evidence to inform clinical practice guidelines for management of hyperglycaemia in adults with DKD. This 2021 guidance is for the variety of clinicians who treat people with DKD, including GPs and specialists in diabetes, cardiology and nephrology.

The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (UK) witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to the conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights the contemporary necessity to equip and empower all maternity stakeholders to deliver the basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational Diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families, aiming to foster long term healthy lifestyle changes. The final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened the “diagnosis to first consultation” intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of GBP 66,384 a year.

Metformin in the management of gestational diabetes

Gestational diabetes mellitus (GDM) is a common pregnancy complication detected especially in the second or third trimester of gestation, with an increasing prevalence over recent decades. Pathophysiologically, GDM develops as a consequence of adative metabolic changes, overlapping a previously unknown pancreatic β-cell dysfunction. The major risk factors for GDM include obesity/overweight, advanced maternal age, family history of insulin resistance and/or diabetes, previous history of gestational diabetes and macrosomia, and the presence of polycystic ovary syndrome (PCOS). Many European countries, including Romania, use selective screening (based on risk factors) as a tool for the detection of GDM. As hyperglycemia is associated with a number of severe maternal and fetal complications, the management of patients with GDM involves a multidisciplinary team consisting of obstetricians, maternal-fetal medicine specialists and diabetes specialists with experience in treating pregnant women. Insulin is the first-choice treatment if lifestyle optimization methods fail. In recent years, attention has focused on oral antidiabetics, specifically on the efficacy and safety of their use as an alternative to insulin treatment. Metformin is an oral antidiabetic of the biguanide class, the first-line treatment for type 2 diabetes outside pregnancy. Due to reduced maternal complications, low cost and increased compliance, the use of metformin in the treatment of GDM is increasing. Most trials have not reported an increased rate of maternal complications in patients treated with metformin. Short-term fetal effects are favorable, but for long-term effects, the results are still unclear. Most medical societies consider metformin safe and effective, but due to a lack of data on the long-term safety profile, it is only recommended for use in cases where insulin therapy is not an option.

Socioeconomic deprivation, age and language are barriers to accessing personal health records: a cross-sectional study of a large hospital-based personal health record system

ObjectivesTo investigate barriers to accessing a hospital-based personal health record (PHR) system.DesignRetrospective cross-sectional study.SettingThis study was conducted in a large secondary and tertiary acute care trust in Birmingham, UK.ParticipantsData were...

Diabetes specialist nurses’ experiences when training patients in the use of insulin pump therapy

Diabetes specialist nurses’ experiences when training patients in the use of insulin pump therapy

Three-Year Glycaemic Control and Management in Patients with Type2 Diabetes Initiating Second-Line Treatment in Japan: A Prospective Observational Study, J-DISCOVER.

IntroductionJ-DISCOVER is a prospective, observational cohort study that aimed to understand characteristics, glycaemic control, comorbidities and real-world management of patients with early-stage type 2 diabetes mellitus (T2DM) in Japan, by enrolling patients initiating second-line treatment from both diabetes specialist and non-specialist care settings.MethodsAs part of the global DISCOVER programme, J-DISCOVER enrolled 1798 patients with T2DM aged at least 20 years old from 142 sites across Japan, from September 2014 to December 2015, and followed these patients for 3 years. Glycaemic control, body mass index (BMI), blood pressure, lipid profiles, treatment patterns, and prevalence of CKD and retinopathy were examined from baseline to 6, 12, 24 and 36 months, stratified by class of second-line treatment.ResultsAt baseline, the median time after T2DM diagnosis was 3.1 years and mean glycated haemoglobin (HbA1c) was 7.7%. The mean individualized HbA1c target was 6.7 ± 0.5%, and 55.3% of patients were set the target of < 7.0%. HbA1c reductions were noted from 6 months and mean HbA1c was 7.1% at 36 months. The proportion of patients with HbA1c < 7.0% increased from 28.8% at baseline to 53.3% at 36 months, and the achievement rate of individualized HbA1c targets increased from 6.1% to 30.3%. Only two cases of severe hypoglycaemia occurred during the study. No major changes in BMI, blood pressure, lipid profile or prescription of antihypertensive or dyslipidaemia medications were observed. The frequencies of screening to detect retinopathy and chronic kidney disease (CKD) were 17.0–21.0% and 14.5–16.0%, respectively, during the follow-up period. The prevalence of CKD, but not retinopathy, increased over the follow-up period.ConclusionsThis study provided an overview of the 3-year management of early-stage T2DM in patients initiating second-line treatment. Contemporary management improved glycaemic control with an acceptable risk–benefit balance, although hurdles remain to sufficient implementation of guideline-recommended treatments in current clinical practice.Trial RegistrationClinicalTrials.gov identifier, NCT02226822.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01192-x.

Differences in Dental Care Referral for Diabetic Patients Between General Practitioners and Diabetes Specialists in Japan, Analyzed from NSAID-Study 3.

IntroductionPeriodontal disease is a common inflammation worldwide and is not only the foremost cause of tooth loss but also a cause of deterioration of glycemic control in patients with diabetes mellitus. In addition, effective glycemic management improves the control of periodontitis infection. The aim of this study was to clarify whether awareness of the need to refer their patients with diabetes to dentists differs between general practitioners and diabetes specialists. This was achieved by secondary analysis of data from the 2018 Nationwide Survey on Actual Intervention for Type 2 Diabetes Mellitus (T2DM) by Japanese Practitioners (NSAID Study).MethodsData from 380 general practitioners and 79 diabetes specialists who participated in the NSAID study and responded to the question of whether they referred T2DM patients to the dentist were analyzed in this study.ResultsThe proportion of general practitioners who referred T2DM patients to dentists was significantly lower than that of diabetes specialists (35.4% vs. 64.1%, respectively).ConclusionThis result suggests that the general practitioners who participated in this study were less cognizant of oral hygiene in patients with diabetes than those who specialized in diabetes. It is also necessary to increase the opportunities for education of physicians who provide diabetic care to promote appropriate dental referrals.

Developing a novel intervention for type 1 diabetes and disordered eating using a participatory action design process: Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY).

To develop a cognitive behavioural therapy-based intervention for people with type 1 diabetes and disordered eating using Experience-Based Co-Design as part of the Safe management of people with Type 1 diabetes and EAting Disorders studY (STEADY). Fifteen people with type 1 diabetes and experience of disordered eating (33±11years old, 22±12years diabetes duration) and 25 healthcare professionals working in type 1 diabetes or eating disorders (44±9years old; 14±10years of professional experience) attended six Experience-Based Co-Design workshops from July 2019 to March 2020 to collaboratively develop intervention content. We developed a cognitive behaviour therapy intervention 'toolkit' that can be tailored for individual patient needs. Participants designed and revised toolkit materials to ensure acceptability and relevance for people with diabetes and disordered eating by engaging in guided discussion, brainstorming, and rapid testing to review toolkit prototypes in an iterative process. Workshop themes were 'Insulin titration'; 'Hypoglycaemia'; 'Coming to terms with diabetes'; 'Fear of weight gain'; 'Toolkit revision'; and 'Practical elements of STEADY therapy'. The intervention is focussed on improving diabetes self-care and embedded in a multidisciplinary healthcare approach. The intervention will be delivered in 12 sessions by a diabetes specialist nurse trained in cognitive behavioural therapy. Through an iterative co-design process, people with type 1 diabetes and healthcare professionals collaboratively developed a novel intervention toolkit that can be used with a wide range of disordered eating presentations. The intervention will be tested in the STEADY feasibility randomised controlled trial.

Integrated diabetes care: The Association of British Clinical Diabetologists (ABCD) national survey report

Executive Summary A national survey on integrated diabetes services was carried out by the Association of British Clinical Diabetologists (ABCD) during the COVID-19 pandemic and has provided some very useful insights into the current state of integration to deliver a joined-up diabetes service in the UK. This survey was carried out during the second half of 2020 and explored three main areas: (1) current state of clinical integration between primary and secondary (specialist) diabetes services; (2) the state of IT integration among the diabetes IT systems and hospital-based electronic patient records (EPR) and between hospital and primary care; (3) to ascertain the membership of their views on a ‘one-stop service’ for collecting annual review data for diabetes and the potential barriers to achieve this. The results presented are a summary of the survey, while the full unedited survey report, especially on the qualitative aspects, is available to ABCD members. The survey was mailed to 518 individuals, of which 431 (83.2%) were consultants and 53 (10.2%) were specialist registrars. Of the 83 replies received, 98% were from consultants and the responses represented a total of 73 hospital diabetes services. The findings of this survey revealed that full integration of clinical services among primary care and specialist diabetes teams is uncommon, although there are good examples of clinical integration in different formats. In a number of areas, primary care and specialist diabetes services continue to work in silos despite a universal recognition that integrated services are desirable and are likely to improve quality of care. Clinical leadership, resources and buy-in from those who commission services were deemed important factors to help improve the development of integrated care systems. In hospitals with dedicated diabetes IT systems the information flow from these diabetes systems to the EPR was not universal, raising concerns that vital information about an individual’s diabetes may not be available to other hospital clinical specialities at the time of delivery of care, posing a significant clinical risk. IT integration among primary and specialist diabetes teams in England was only available in certain areas and was mostly based around the use of SystmOne. The survey also identified a diversity of opinions regarding the current arrangements of the Quality Outcome Framework (QOF), where GPs are incentivised to collect data for annual review of routine diabetes care. Many were of the opinion that annual review processes should be performed by clinical teams who are tasked to deliver diabetes care to the individual, while others felt that the status quo should continue with primary care GPs being responsible. A one-stop service for eye screening for diabetes and other annual measurements nearer to people’s homes was identified as an improvement, but several logistic barriers were identified. We recognise the limitations of any survey which expresses opinions of participants. However, we believe the present survey represents a significant proportion of diabetes units in the UK and provides insights into the current state of integrated services in diabetes. There are significant learnings for diabetes communities, and the information can be used to improve and galvanise delivery of integrated diabetes care in the UK.

AACE2021-A-1078: The Changeable Dynamics Between Glycaemic Control and Neuropathy Risk Across the Lifespan of Saudi Diabetic Patients; a Survey in Diabetes Healthcare Facility

This study aims to evaluate the prevalence of such a common and morbid neuropathy complication in a sample of Saudi diabetic patients. A descriptive questionnaire-based cross-sectional survey was conducted of sample of all diabetic patients who attend the specialist diabetes and endocrine centre in Prince Mansour Military Hospital in Taif, Saudi Arabia. A monofilament test was used to identify peripheral neuropathy cases, whereas its associated factors were identified through generalized linear logistic regression analysis. The study included (n = 343) diabetic patients. The prevalence of peripheral neuropathy was 84.8% affected patients (n = 291). Dyslipidaemia increased the risk for neuropathy by 98.4% (P = 0.04614). An interaction existed between the duration of diabetes and HbA1c levels in terms of their effect on peripheral neuropathy. When the interaction term is included, a positive association between neuropathy and both HbA1c (increased risk by 46.2%, P = 0.03222) and DM duration (increased risk by 19.6%, P = 0.04497). Cardiovascular disease reduced neuropathy risk by 62.1% (P = 0.03516), and retinopathy reduced neuropathy risk by 60.9% (P = 0.00782). over four out of every five patients have peripheral neuropathy. This is because our study was conducted among a high-risk group of attendees at the specialist diabetic centre. Dyslipidaemia, poor glycaemic control, and longer diabetes duration were associated with peripheral neuropathy in our participants, confirming a direct nerve-damaging effect for high levels of lipoproteins, glucose and lipids in the blood.