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News ArticleNHS England patients with Type 1 diabetes will now be eligible for life-changing continuous glucose monitors after the health service secured a new cut-price deal. The wearable arm gadget sends information to a mobile app and allows diabetes patients to keep track of their glucose levels at all times without having to scan or take a finger prick test. Traditionally, continuous glucose monitors are more expensive than their flash monitor counterparts – which record glucose levels by scanning a sensor – but thanks to the NHS agreeing on a new cost-effective deal with manufacturers DEXCOM, they will now be available for NHS patients on prescription at a similar price. The monitor, called Dexcom ONE Real Time-Continuous Glucose Monitoring, uses a sensor no bigger than a bottle cap that attaches to the arm for up to 10 days and measures glucose levels from just under the skin. Patients will receive their starter pack – which will include information on the product and usage, a sensor and transmitter – from the hospital or GP surgery once prescribed, after which they can go to the pharmacy for their repeat prescription. Dr Partha Kar, national speciality advisor for diabetes and obesity said: “This is a huge step forward for Type 1 diabetes care and these monitors will be life-changing for anyone with the illness – giving them more choice to manage their condition in the most convenient way possible – as well as the best chance at living healthier lives, reducing their risk of hospitalisation and illnesses associated with diabetes, which in turn reduces pressure on wider NHS services. “The new deal also delivers on our commitment to get patients the latest cutting-edge medical technology at the best value for taxpayer money – saving the NHS millions over the coming years”. Read full story Source: NHS England, 2 August 2022 You may also be interested in: “I felt lucky to get out alive”: why we must improve hospital safety for people with diabetes Peer support makes a big difference to living with type 1 diabetes Improving safety for diabetic inpatients: 4 key steps - Interview with Dr Partha Kar
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In this blog, Lotty Tizzard, Patient Safety Learning’s Content and Engagement Manager, looks at the safety issues faced by people with diabetes in hospital settings. Reflecting on feedback from Twitter users with diabetes, she looks at why so many people with diabetes fear having to stay in hospital, and asks what the NHS and its staff can do to make it a safer, less stressful environment. -
Community Post
People with diabetes' experience of care in hospitals
Patient-Safety-Learning posted a topic in Diabetes
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These comments were made by people with diabetes in response to a Twitter thread asking "Why is a hospital stay scary if you have diabetes?" If you have diabetes, or care for someone who does, please share your experience with us by adding a comment to this community thread, “I was in ICU after a car accident—none of the staff knew how to work my CGM and/or my insulin pump. I had to manage my own care” “For me it was when I went into hospital for surgery and the nurse said 'Type 1... so do you take insulin for that?'... that's not a reassuring thing to hear minutes before you're taken into the theatre!” “Lucky to get out alive.” “DKA 10 years ago, once back in normal range the consultant insisted I didn't need anymore insulin & refused to let me have any. Obvs within 3 hours I was back in DKA, he wouldn't come see me but had a convo with my husband on the ward phone where hubs explained how T1 works.” “I've been given a full day's bolus, through my iv and then told I was wrong when I said that I only bolused when I ate. Massive hypo followed quickly. I was then told it was my fault and I should have said something.” “After being admitted as an emergency, my own insulin ran out. I was given 2 (2!) of the wrong types of insulin and told that 'it would be okay'.” “They were often confused about T2 versus T1 - lots of emphasis about low fat foods and only being allowed a low fat yoghurt for puddings even though I was on a pump! I had a bag of snacks though as it was a planned hospital stay” “After a major medical issue I was denied insulin in the ICU for over 24 hours but was told I could have some pills to treat my type 1 diabetes” “Last time I went to the hospital, they took my pump (forcefully) and refused to give it back. When I protested, they sedated me. I was in and out of sedation having a panic attack bc I couldn’t breathe. They sedated me again and put me on DKA protocol, even tho I wasn’t in DKA.” “it’s so scary right like you know that you’re the expert on your condition and your needs but that power gets totally taken away” “Handing over your care over to a group of nurses who have no idea what they are doing. It’s super scary. I hate it when they lock it all away and you can’t get to it.” “I didn’t feel safe either. Told them on a few occasions I felt ‘low’. Finally Lucozade got wheeled out but it was almost an inconvenience” “Totally understand why they don’t know much about it if it’s not their specialism BUT some are so arrogant that what they were told one afternoon 10yrs ago is the absolutely way to deal with, and that the person living with it doesn’t know what they’re talking about!” Sarcastic responses “You seem to know a lot about it!” “The neurologist told me I am a terrible diabetic.” “I never feel safe because they don’t allow me to dose my own insulin and last time dropped me from 600 to 40 in three hours and then shot me back up so fast when i specifically told them that i would go low and high from that much insulin” Report of being diagnosed with type 1 diabetes while in hospital, despite telling every healthcare professional she had T1. “I smuggled in my own tester and meds and took care of myself.” “I think the biggest thing for me is them not understanding insulin dose when they’re writing up your chart and how you don’t really have a “typical” insulin dose that fits neatly into their charts because of carb counting or correction doses/reduction dose. It’s strange, when I’ve had DKA admissions and I’m on the sliding scale IV it’s fine because there’s clear guidelines but for just day to day injection management it’s soooo difficult.” "Daughter had food and insulin withheld in a mental hospital." “the ward nurses didn’t even know I had T1 until the more mobile lady opposite me went and fetched a nurse who had been ignoring my call button. I was hypo and couldn’t reach my treatment.” "Taken off insulin for two days as no doctor to prescribe." “Particularly bad experience when a nurse left the glucose drip on but turned off the insulin. It terrifies me to think how bad this could have been.”- Posted
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News ArticlePatients who contract Covid-19 are at increased risk of being diagnosed with cardiovascular disorders and diabetes in the three months following infection, although the risk then declines back to baseline levels, a large UK study has found. Researchers from King’s College London say patients recovering from Covid-19 should be advised to consider measures to reduce diabetes risk including adopting a healthy diet and taking exercise. The GP medical records from more than 428,650 Covid-19 patients were matched with the same number of controls and followed up to January 2022. All patients with pre-existing diabetes or cardiovascular disease were excluded from the study, published in the open access journal PLOS Medicine. According to the analysis, diabetes mellitus diagnoses were increased by 81% in acute covid-19 and remained elevated by 27% from 4 to 12 weeks after infection. Lead study author Emma Rezel-Potts said, “While it is in the first four weeks that covid-19 patients are most at risk of these outcomes, the risk of diabetes mellitus remains increased for at least 12 weeks. Clinical and public health interventions focusing on reducing diabetes risk among those recovering from covid-19 over the longer term may be beneficial.” The researchers said that people without pre-existing cardiovascular disease or diabetes who become infected with covid-19 do not appear to have a long term increase in incidence of these conditions. Read full story Source: BMJ, 22 July 2022
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Content ArticleCOVID-19 has been associated with new-onset cardiovascular disease (CVD) and diabetes mellitus (DM), but it is not known whether COVID-19 has long-term impacts on cardiometabolic outcomes. This study from Rezell-Potts et al. aimed to determine whether the incidence of new DM and CVDs are increased over 12 months after COVID-19 compared with matched controls. The study found that CVD was increased early after COVID-19 mainly from pulmonary embolism, atrial arrhythmias, and venous thromboses. DM incidence remained elevated for at least 12 weeks following COVID-19 before declining. People without preexisting CVD or DM who suffer from COVID-19 do not appear to have a long-term increase in incidence of these conditions.
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Content ArticleThis is the annual report of the National Diabetes Inpatient Audit–Harms (NaDIA-Harms) programme, which aims to monitor and reduce instances of key life-threatening diabetes specific inpatient events. The programme covers hypoglycaemic rescue, diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) and diabetic foot ulcer. Overall 4,605 inpatient harms were submitted to the NaDIA-Harms audit between May 2018 and October 2020; the majority of which related to hypoglycaemic rescue (69%). This report also covers: the number of submissions of each inpatient harm. the impact of the Covid-19 pandemic on inpatient harms. patient profiles of people that experience each inpatient harm. These include demographics, diabetes characteristics, treatment targets, care processes, admission characteristics and comorbidities.
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Content Article
PRSB Diabetes standards (July 2022)
Patient-Safety-Learning posted an article in Diabetes
People with diabetes are increasingly using medical devices to help manage their condition, including devices for monitoring glucose and delivering insulin. However, healthcare professionals are finding that they cannot always access up to date information about a person with diabetes and the data from their medical devices. This makes it harder to provide the best advice and support. The Professional Record Standards Body (PRSB) was commissioned by NHS England and NHS Improvement to produce two standards for sharing diabetes information between people and professionals across all care settings, including self management data from digital apps and medical devices (for example, continuous glucose monitors). The Diabetes Information Record Standard which defines the information needed to support a person’s diabetes management. It includes information that could be recorded by health and care professionals or the person themselves that is relevant to the diabetes care of the person and should be shared between different care providers. The Diabetes Self-Management Standard which defines information that could be recorded by the person (or their carer) at home (either using digital apps or medical devices) and shared with health and care professionals. -
Content Article
In this blog Patient Safety Learning considers the safety concerns highlighted by a recent report by the Healthcare Safety Investigation Branch (HSIB) into the administration of high-strength insulin from pen devices in hospitals. This blog argues that without specific and targeted recommendations to improve patient safety in this area, patients will continue to remain at risk from similar incidents. -
Content ArticleThis Healthcare Safety Investigation Branch (HSIB) investigation aims to help improve patient safety in relation to administering high-strength insulin from a pen device to patients with diabetes in a hospital setting. As its ‘reference case’, the investigation uses the experience of Kathleen, a 73 year old woman with type 2 diabetes who received two recognised overdoses of insulin while she was in hospital. On both occasions she became hypoglycaemic, received medical treatment, and recovered. Patient Safety Learning has published a blog reflecting on some of the key patient safety issues highlighted in this report.
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Content Article
Blog - When diabetes devices fail (8 December 2020)
Patient-Safety-Learning posted an article in Diabetes
In this article for US magazine Consumer Reports, Rachel Rabkin Peachman looks at the incidence and impact of malfunctions and design flaws in continuous blood glucose monitors, insulin pumps and other diabetes equipment. She highlights the case of Pamela, a 64-year-old with diabetes who died when her insulin pump unintentionally gave her a massive dose of insulin overnight. The numbers of adverse events and deaths reported to the FDA regarding diabetes devices is far greater than for any other type of medical device—between January 2019 and July 2020, almost 400 deaths and 66,000 injuries in the US were linked to commonly used diabetes devices. Reports are spread across the different device manufacturers and demonstrate the complexities of trying to determine the exact cause of each adverse event. The article also includes information on how people with diabetes can protect themselves from device malfunctions and errors. -
Content ArticleThis Healthcare Safety Investigation Branch (HSIB) investigation explores medicines omission among patients with learning disabilities who are cared for in medium and low secure wards in mental health hospitals. A medicine omission is when a patient doesn't receive medicines that have been prescribed to them, and the investigation focused on a number of factors that could contribute to omission: the environment in which medicines administration takes place the availability and use of learning disability nurses in these environments the skills required for nurses to help patients with learning disabilities be involved in choices about their medicines. For it's reference event, the investigation looked at the case of Luke, who was detained in a medium secure ward of a mental health hospital. He spent 21 months on the ward before moving into a low secure ward at the same hospital, where he stayed for a further 11 months. Both wards were specifically designated for patients with learning disabilities. While at the hospital, there were a number of periods when Luke was not given the physical health medication he had been prescribed for his diabetes and high cholesterol. Although Luke’s medication record regularly noted that Luke refused the medication, Luke and his Mother disagreed with this version of events, stating that other factors led to Luke’s medicine omissions.
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Content ArticleStaying in hospital can be a frightening experience for people with diabetes. In 2017, an estimated 9,600 people required rescue treatment after falling into a coma following a severe hypoglycaemic attack in hospital and 2,200 people suffered from Diabetic Ketoacidosis (DKA) due to under treatment with insulin. This report by Diabetes UK outlines the patient safety issues and suggests the following measures are needed to make hospitals safer for people with diabetes: multidisciplinary diabetes inpatient teams in all hospitals better support in hospitals for people to take ownership of their diabetes better access to systems and technology more support to help hospitals learn from mistakes strong clinical leadership from diabetes inpatient teams knowledgeable healthcare professionals who understand diabetes.
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News ArticleDiabetes patients have been warned that non-attendance at eye-test appointments puts them at greater risk of developing unnecessary sight loss. The Royal National Institute for the Blind (RNIB) has described the attendance rates at clinics in Northern Ireland as "alarmingly low" . It said 20% to 40% of patients were not showing up for their appointments on any given day. Prof Tunde Peto, clinical lead for the NI Diabetic Eye Screening Programme, said the most common of many complications caused by diabetes was diabetic eye disease. Diabetes can cause cataracts early on but it can also affect the retina at the back of the eye, "which will eventually lead to sight loss if not treated on time," Prof Peto explained. "Diabetic retinopathy causes no symptoms until it can be just about too late to treat," she said. Ian Catlin from Ballymoney has experienced sight loss due to diabetic retinopathy. He has had Type 1 diabetes since childhood and became aware of problems with his eyesight in his mid-30s. Mr Catlin said he put off asking for medical help because of the fear of what he would be told."I did eventually go, but you're scared and you put your head in the sand," he said.Read full story Source: BBC News, 15 June 2022
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Content Article
Type 1 diabetes is a life-long condition that causes the level of glucose in a person’s blood to be too high. It is caused by the body’s immune system attacking the cells in the pancreas that produce insulin, the hormone that allows the body to use glucose as energy. It cannot be cured, and people with diabetes need to inject or infuse insulin multiple times a day to control their blood sugar levels. Peer support communities can help people with type 1 diabetes to manage their condition safely and feel less isolated. In this blog, Paul Sandells, a diabetes peer supporter and advocate, talks about the important role of peer support in helping people with type 1 diabetes improve their blood glucose control and deal with the burden that diabetes can place on daily life. -
News Article
Child diabetes referrals in England and Wales jump 50% amid obesity crisis
Patient Safety Learning posted a news article in News
The number of children being treated at paediatric diabetes units (PDUs) in England and Wales has increased by more than 50% amid a “perfect storm” of rising obesity levels and the cost of living crisis, health leaders have said. Diabetes UK said alarming obesity levels among children had led to a “concerning climb” in the number diagnosed with type 2 diabetes, and predicted that the cost of living crisis could lead to further problems in the years to come. Data from NHS Digital shows that almost one in seven children start primary school obese – a rise of almost 50% in just a year. More than a quarter are obese by the time they finish primary school. The high levels of obesity combined with the squeeze on personal finances are creating a “perfect storm which risks irreversible harm to the health of young people”, Diabetes UK said. It accused the government of “letting our children down” as it called for concerted action to tackle obesity. Chris Askew, the chief executive of Diabetes UK, said: “We are very concerned that this spike in childhood obesity will translate into an even greater increase in children with type 2 diabetes in the coming years, a crisis fuelled by longstanding health inequalities and made worse still by impacts of the cost of living crisis." Read full story Source: The Guardian, 15 June 2022 -
News Article
Covid lockdown blamed for deaths of more than 3,000 people with diabetes
Patient Safety Learning posted a news article in News
A lack of diabetes checks following the first Covid lockdown may have killed more than 3,000 people, a major NHS study suggests. Those with the condition are supposed to undergo regular checks to detect cardiac problems, infections and other changes that could prove deadly. But researchers said a move to remote forms of healthcare delivery and a reduction in routine care meant some of the most crucial physical examinations did not take place during the 12 months following the first lockdown. Experts said the findings showed patients had suffered “absolutely devastating” consequences and were being “pushed to the back of the queue”. The study, led by Prof Jonathan Valabhji, the national clinical director for diabetes and obesity, links the rise in deaths to a fall in care the previous year. It showed that, during 2020/21, just 26.5% of diabetes patients received their full set of checks, compared with 48.1% the year before. Those who got all their checks in 2019-20 but did not receive them the following year had mortality rates 66% higher than those who did not miss out, the study, published in Lancet Diabetes and Endocrinology, found. The study shows that foot checks, which rely on physical appointments, saw the sharpest drop, falling by more than 37%. “The care process with the greatest reduction was the one that requires the most in-person contact – foot surveillance – possibly reflecting issues around social distancing, lockdown measures, and the move to remote forms of healthcare delivery,” the study found. Those in the poorest areas were most likely to miss out. Read full story (paywalled) Source: The Telegraph, 30 May 2022 -
Content ArticleThe Office for Health Improvement and Disparities, part of the UK Government Department of Health and Social Care, highlighted an emerging signal of increased non-COVID-19-related deaths in England between July and October, 2021, with a potentially disproportionate higher increase in people with diabetes. Valabhji et al. aimed to substantiate and quantify this apparent excess mortality, and to investigate the association between diabetes routine care delivery and non-COVID-19-related-mortality in people with diabetes before and after the onset of the pandemic. They examined whether completion of eight diabetes care processes in each of the two years before the index mortality year was associated with non-COVID-19-related death. Results of the study show an increased risk of mortality in those who did not receive all eight care processes in one or both of the previous two years. These results provide evidence that the increased rate of non-COVID-19-related mortality in people with diabetes in England observed between 3 July and 15 October 2021 is associated with a reduction in completion of routine diabetes care processes following the pandemic onset in 2020.
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Content ArticleThis qualitative descriptive study in the journal BMC Nursing aimed to analyse the experiences of patients with type 2 diabetes during the stay-at-home order in place during the first wave of the Covid-19 pandemic. It looked at the experiences of ten patients with type 2 diabetes living in Catalonia and identified the strategies and resources they used to manage their care. The study found that many people with type 2 diabetes reported effective self-care during confinement and were able to adapt well using the resources available, without face-to-face contact with primary care health staff.
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News ArticleThe Medicines and Healthcare products Regulatory Agency (MHRA) has issued a national patient safety alert for the NovoRapid PumpCart prefilled insulin cartridge and the Roche Accu-Chek Insight Insulin pump system following concerns raised about cracked cartridges and insulin leaks. Patients are being asked to check the pre-filled glass insulin cartridge for cracks prior to use. The cartridge should not be used if it has been dropped even if no cracks are visible. Closely follow the updated handling instructions in the pump user manual when changing pre-filled glass insulin cartridges. The device, which releases the insulin your body needs through the day and night, comprises a pump, tube, battery and a pre-filled glass insulin cartridge. In some of the reported leakage incidents, the cartridges were found to be cracked and provided an inadequate supply of insulin to patients. However, leakages also occurred in cases where no cracks in the cartridge were visible. In some patients there were consequences of not receiving enough insulin from their pump system, including reports of severely high blood sugar and diabetic ketoacidosis (a serious complication of diabetes when the body produces high levels of blood acids called ketones). Health care professionals are being advised to contact patients over the next six months using said device to discuss their individual needs and source an alternative pump where appropriate. Key patient recommendations are: Check the pump and cartridge regularly for damages, for example cracks or leakage. If you smell insulin (a strong antiseptic chemical smell) this could also indicate a leakage. Do not use the cartridge if cracks or leakage are seen or if the cartridge was dropped. Follow the instructions of your Accu-Chek Insight user manual for replacing a cartridge and for cleaning the cartridge compartment in the insulin pump. During the day and before going to sleep please carefully check that your insulin pump is delivering insulin and there are no leakages. Never change treatment delivery methods without first consulting a relevant healthcare professional. Failure of insulin delivery due to leakage may not result in an alert notification from the insulin pump and cracks and leakages may not always be visible. You should check blood glucose levels multiple times throughout your day whilst using pumps. Tell your healthcare professional immediately if you suspect a problem with your insulin delivery. Read full story Source: Gov.UK, 26 May 2022
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Content ArticleThe MHRA continues to receive serious reports of harm associated with insulin leakage for the NovoRapid PumpCart prefilled insulin cartridge in the Accu-Chek Insight Insulin pump. In some patients, there were serious consequences arising from inadequate supply of insulin, including diabetic ketoacidosis (DKA). Although the manufacturer Roche Diabetes Care (RDC) has implemented a number of risk minimisation strategies to reduce the incidence of these events, the impact of these is inconclusive and we are taking further action to protect patients. To protect patient safety, diabetes healthcare professionals should inform patients who use the Accu-Chek Insight of the risk of leakage. Clinical care decisions should be made to ensure patients are moved onto alternative pumps where possible.
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Content Article
Safe care for people with diabetes in hospital (January 2020)
Patient-Safety-Learning posted an article in Diabetes
This article in the journal Clinical Medicine looks at the safety of people with diabetes when they are admitted to hospital as an inpatient. Having diabetes in hospital is associated with increased harm. Although the National Diabetes Inpatient Audit has shown that inpatient care for people with diabetes has slowly improved over the last few years, there are still challenges in terms of providing appropriate staffing and education. Progress is still needed to ensure the safety of people with diabetes in hospital. The authors look at some of the key areas of concern for people with diabetes in hospital, including increased risk of hypoglycaemia, hyperglycaemia (including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemia state), medication errors, hospital acquired foot ulcers, increased length of stay and overall increase in death. -
Content ArticleEffective Diabetes Education Now (EDEN) has created some resources for healthcare professionals to ensure vital information about insulin safety is communicated in way that supports the reduction of insulin errors. This webpage features infographic posters and a video about insulin safety.
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News Article
Fear over high rates of diabetes foot amputations
Patient Safety Learning posted a news article in News
Major differences in the rate of foot amputations for people with diabetes in England are incredibly concerning, patient groups say. Such amputations are a sign patients have not received adequate care, as poorly controlled diabetes increases the risk of foot ulcers and infections. One in 10 areas had "significantly higher rates", government data shows. There was nearly a five-fold difference between the best and worst when taking into account risk factors such as age. The government data - published by the Office for Health Improvement and Disparities - looked at the three years leading up to the pandemic. It is believed up to 80% of foot amputations could be avoided with better care. Diabetes UK said the figures "shined a light on the scale of the crisis facing diabetes care" and it warned access to support was likely to have become worse during the pandemic. A report produced by the charity earlier this month said lives would be needlessly lost because of disruption to services over the past two years. Diabetes UK chief executive Chris Askew said the latest figures were "incredibly concerning". "The majority of these major amputations are preventable, but many people living with diabetes are struggling to access the care they need - and in areas of higher deprivation, people are experiencing worse outcomes. These inequalities must be addressed." Read full story Source: BBC News, 27 April 2022 -
Content ArticleYoung people with type 1 diabetes experience higher rates of psychological distress, periods of burnout and feelings of being unable to cope with the daily burden of living with diabetes, than those who are diagnosed as adults. This article in The BMJ considers approaches to reduce anxiety and stress in young people with diabetes including: family, peer, and psychological support and education on living with diabetes. psychological screening assessment tools at diagnosis and annually. ensuring there are adequate local mental health support pathways. psychological and behavioural interventions, such as solution focused therapy, coping skills training, motivational interviewing and cognitive behavioural therapy.
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Content ArticleThe National Paediatric Diabetes Audit (NPDA) is performed annually in England and Wales and aims to provide information that leads to improved quality care for children and young people affected by diabetes. The audit is funded by the Department of Health through the Healthcare Quality Improvement Partnership (HQIP). Key messages in this 2020-21 annual report on care processes and outcomes include: There was an increase of an increase of 20.7% in the number of children aged 0-15 diagnosed with type 1 diabetes compared with 2019-20. Completion rates on recommended health checks were lower than in previous years due to the impact of the Covid-19 pandemic. There was wide variation between paediatric diabetes units in the completion rates of all key annual health checks. A smaller percentage of newly-diagnosed children and young people started insulin pump therapy compared to previous years. The national median HbA1c (a measure of blood glucose control) reduced from 61.5 mmol/mol to 61.0mmol/mol between 2019/20 and 2020/21, following several years of year on year decreases (improvement) in the national median. Children from ethnic minorities were less likely to be using insulin pumps and continuous glucose monitors (CGMs) than white children. However, the highest percentage increase between audit years in the use of CGMs was seen in black children and young people with type 1 diabetes.
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