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Content ArticleDespite the prevalence of diabetes amongst individuals with Serious Mental Illness (SMI), diabetes care is not currently audited within mental health inpatient settings as it audited in physical health settings. This project piloted an audit to assess the diabetes care within London NHS Mental Health Trusts. The Health Innovation Network in partnership with South London and Maudsley NHS Foundation Trust (SLaM) developed and piloted a diabetes audit. Following the SLaM pilot, the audit was completed by all nine London Mental Health Trusts. A diverse approach was taken to spread and adoption. This included piloting the audit within one MH Trust, refining, and then rolling out the audit to eight London Mental Health Trusts.
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Content ArticleHampshire and Isle of Wight Integrated Care System (ICS) has achieved great results in supporting access to the NHS Diabetes Prevention Programme. This case study outlines the approach taken by the ICS to improve access, what the outcomes were and key lessons learned.
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Content ArticleThere are reports of increasing incidence of paediatric diabetes since the onset of the COVID-19 pandemic. This study by D'Souza et al. compares the incidence rates of paediatric diabetes during and before the COVID-19 pandemic. The study found that incidence rates of type 1 diabetes and diabetic ketoacidosis at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.
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Content ArticleThe widespread adoption of effective hybrid closed loop systems would benefit people living with type 1 diabetes by improving the amount of time spent within target blood glucose range. Hybrid closed loop systems (also known as 'artificial pancreas' typically utilise simple control algorithms to select the best insulin dose for maintaining blood glucose levels within a healthy range. Online reinforcement learning has been utilised as a method for further enhancing glucose control in these devices. Previous approaches have been shown to reduce patient risk and improve time spent in the target range when compared to classical control algorithms, but are prone to instability in the learning process, often resulting in the selection of unsafe actions. This study in the Journal of Biomedical Informatics presents an evaluation of offline reinforcement learning for developing effective dosing policies without the need for potentially dangerous patient interaction during training.
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Content Article
Language Matters pocket guides (April 2023)
Patient-Safety-Learning posted an article in Diabetes
The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day-to-day. At its best, good use of language; verbal, written and non-verbal (body language) which is more inclusive and values based, can lower anxiety, build confidence, educate and help to improve self-care. On the other hand, poor communication can be stigmatising, hurtful and undermining of self-care and have a detrimental effect on clinical outcomes. Language Matters Diabetes is a global movement that aims to improve the way in which healthcare professionals and wider society talks about and to people with diabetes. These three pocket guides for different groups aim to address use of language about diabetes and people with diabetes in order to improve experiences of care and tackle stigma. Language Matters pocket guide: Healthcare professionals Language Matters pocket guide: Parents and families Language Matters pocket guide: Media and social media -
Content ArticleOn the 9 October 2021 an investigation was carried out into the death of Ms Sandra Diane Finch, a 44 year old woman who had a history of Type 1 diabetes mellitus. The investigation concluded at the end of the inquest on 3 May 2023. The conclusion of the inquest was a narrative conclusion of ketoacidosis due to insulin depravation contributed to by neglect. The cause of death was: 1a) Ketoacidosis 1b) Uncontrolled Type 1 Diabetes Mellitus 1c) Insulin depravation.
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Content ArticleDesigned by the Inpatient Diabetes Team at University Hospital Southampton (UHS), the DiAppBetes app for healthcare professionals aims to provide easy access to clinical guidance on managing patients with diabetes in hospital. It allows all healthcare professionals—including non-specialists—to quickly check up to date guidance on: the basics of diabetes. screening and diagnosis. type 1 diabetes guidance notes. patient assessment. complications of diabetes. patients with diabetes in a variety of scenarios, including pregnancy, about to have surgery, new to insulin, using an insulin pump and at the end of life. diabetes treatments. The app is freely available and content is generic apart from a few hospital-specific contact details. Hospitals using the Microguide platform for antibiotic guidance can reconfigure the format of the app—if they do this, hospitals should ensure that UHS is acknowledged as the original provider of the app.
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Content Article
The inpatient diabetes team at University Hospital Southampton NHS Foundation Trust recently launched D1abasics, an initiative that aims to improve inpatient care for people with diabetes. In this blog, Diabetes Consultant Mayank Patel and Inpatient Diabetes Specialist Nurse Paula Johnston outline the approach and explain how it will equip staff across all specialties with the basic knowledge to care safely for people with diabetes in hospital. -
Content Article
D1abasics campaign resources (UHS, May 2023)
Patient-Safety-Learning posted an article in Diabetes
People with diabetes account for one in three hospital inpatients, and this is projected to increase to one in five in the next few years. Often, people are in hospital for reasons other than their diabetes, so it is important that staff across all specialties understand the basics of diabetes care in order to ensure patient safety. D1abasics is an innovative project that aims to equip all healthcare professionals to support the basic diabetes healthcare needs of their patients. Developed by the diabetes team at University Hospital Southampton with funding and support from the charity Diabetes UK, the campaign includes resources such as posters, lanyards and prompt cards. The diabetes team is supporting learning across the hospital by making visits to all wards and specialties to promote D1abasics. You can download the D1abasics poster below. -
Content Article
Partha Kar, National Specialty Advisor for NHS England, has led work that has had an enormous impact for patients and for patient safety. In this video podcast, Steph O'Donohue from Patient Safety Learning talks to Partha about his leadership style and how it has helped him drive forward significant change in an often challenging context. Partha talks about the power of the patient community, workforce morale, sharing failures and leading with honesty. -
Content Article
Diabetes care: Is it fair enough? (Diabetes UK, 10 May 2023)
Patient Safety Learning posted an article in Diabetes
Missed checks, disrupted care and health inequalities have been revealed in a new report from Diabetes UK looking at the state of diabetes care in England. The report reveals that less than half (47%) of people living with diabetes in England received all eight of their required checks in 2021-22, meaning 1.9 million people did not receive the care they need. It is calling for urgent action to address the routine diabetes care backlog and prevent avoidable deaths of people living with diabetes. -
News ArticleDiabetes is killing an increasing number of Americans and has accounted for more than 100 000 US deaths in each of the past two years. A national commission has called on the federal government to take a broad approach to the problem, similar to the fight against AIDS. Lisa Murdock of the American Diabetes Association told The BMJ that diabetes was the most common underlying condition in the US and that Covid-19 was an exacerbating factor. Some 40% of Americans who died from Covid-19 had diabetes, she said. The Centers for Disease Control and Prevention has reported that 37.3 million Americans—11.3% of the US population—have diabetes, including 8.3 million who have not had it diagnosed. Read full story (paywalled) Source: BMJ, 3 February 2022
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News Article
Substantial fall in diabetic health checks as GPs reprioritised during pandemic
Patient Safety Learning posted a news article in News
The proportion of patients with type 2 diabetes who have had recommended health checks has fallen substantially, provisional data from 2021 suggests, as have the numbers hitting key disease control targets. In response, primary care experts have called for GP practices to receive targeted investment to focus on the checks, which they had to deprioritise as the vaccination programme was introduced. There are now 3.24 million people with a diagnosis of type 2 diabetes in England, the data across all GP practices shows. National Diabetes Audit figures for England from January to September 2021 showed that: 74% of patients had received a HbA1c check and 70% a blood pressure check compared with 93% and 95% respectively in 2019/20. In the first nine months of last year, 61.9% of patients had an HbA1c under 58 mmol/mol, compared with around 66% in previous years. The proportion of patients with blood pressure targets of under 140/80 was 66.5% in the latest figures compared with around 73-74% during 2015 to 2020. Speaking with Pulse, Professor Partha Kar, NHS England national specialty advisor for diabetes said while this was not the final data, a drop off had been expected for a range of reasons outside GPs control. ‘What we have seen is that there was a massive drop off in wave one. Then around the middle of 2020 it started to pick up again but then it’s dropping off again so irrespective of data cleaning, I suspect you will see a massive drop off compared to where things have been over the last four or five years. ‘We need to be very clear its not because anyone was twiddling their thumbs, it’s because primary care was asked to do something else. ‘We can’t go back to primary care again for the vaccines because they are being taken away from the thing that they’re amazing at which is delivering long-term conditions at scale.’ Read full story Source: Pulse, 2 February 2022 -
News Article
Resident died after treatment at failing care home
Patient Safety Learning posted a news article in News
A resident at an inadequate care home died after their blood glucose increased to high levels and staff acted too slowly, a report found. Inspectors said The Berkshire Care Home in Wokingham breached guidelines in nine areas and must improve. They found residents were put at risk after medicines were not used properly and that records were not up to date. The Care Quality Commission (CQC) said an ambulance was only called for the person who died when they were found to be unresponsive. They later died in hospital. Its report said staff were "not sufficiently skilled" to safely care for people with diabetes. A resident was given paracetamol and co-dydramol eight times over three days, when they should not be used together because they both contain paracetamol, the report said. Another person was burned by a cup of tea and staff did not treat the injury properly, leading to the person developing an infection and later being admitted to hospital. Staff sometimes felt "rushed and under pressure", the report found. Read full story Source: BBC News, 18 December 2021 -
News Article
Blood pressure drugs could prevent type 2 diabetes, study finds
Patient Safety Learning posted a news article in News
Blood pressure drugs could prevent millions of people worldwide from developing type 2 diabetes, a large study suggests. Lowering high blood pressure is an effective way to slash the risk of the disease in the future, according to the research published in the Lancet. Doctors already prescribe cheap blood pressure drugs to reduce the chances of a life-threatening heart attack or stroke. However, until now, the question of whether these drugs could also help fend off the threat of type 2 diabetes had been unanswered. Now researchers have found the protective effects of the drugs are much wider than previously thought. The study shows they may directly reduce someone’s risk of type 2 diabetes, a condition that an estimated 13.6 million people in the UK are at high risk of developing. Currently, health experts say being a healthy weight and adopting a healthy lifestyle is the best way to reduce the risk of type 2 diabetes. Researchers say existing drugs – particularly ACE inhibitors and ARBs – should now be considered for some patients who are at higher risk of the disease. Prof Kazem Rahimi, lead researcher of the study at the University of Oxford and a consultant cardiologist, said: “Our research provides clear evidence that giving ACE inhibitors or ARBs, which are widely available and affordable worldwide, to patients at high risk could curb the growing burden of type 2 diabetes.” Read full story Source: The Guardian, 11 November 2021 -
News Article
Scotland to rollout diabetes test for Type 1 patients
Patient Safety Learning posted a news article in News
Misdiagnosed Type 1 diabetes patients could be freed from the need to take insulin after a new test is rolled out. Scotland will become the first country to offer the C-peptide blood test to all patients who have had a Type 1 diagnosis for at least three years. The test shows how much insulin a patient's body is producing itself. A pilot by NHS Lothian allowed some people who had been taking insulin to stop or reduce the treatment. The test will be available from 1 November. C-peptide testing, which has been used as part of diagnosis for some patients for many years, can help distinguish whether a patient has Type 1 or Type 2 diabetes. C-peptide is made in the body at the same time as insulin. By testing levels of C-peptide, doctors can work out how much insulin a diabetes patient is making themselves. If C-peptide is present in significant amounts, it might indicate that the person does not have Type 1 diabetes at all, and consequently may not need daily insulin injections. The tests will be offered at hospital diabetes centres. Public Health Minister Maree Todd said that tackling diabetes was a priority for the Scottish government and that she wanted everyone living with diabetes to access safe, effective healthcare, treatment and support. She said: "Type 1 diabetes is a significant health challenge right across the world." Read full story Source: BBC News, 31 October 2021 -
News Article
'Diabetes burnout': The mental health impact of diagnosis
Patient Safety Learning posted a news article in News
"It's a full-time job that you can't quit. It's a massive burden that you didn't ask for, didn't expect." Diagnosed with type 1 diabetes at the age of 19, Naomi, now 33, says she reached a point where she simply could not handle "the physical or mental challenges of diabetes any more", a condition known as "diabetes burnout". About 250,000 people in England have type 1 diabetes, which means the body cannot produce insulin, the hormone that controls blood sugar levels. It can lead to organ damage, eyesight problems and - in extreme cases - limb amputation. But for many there is also a significant psychological impact of learning to manage the condition. Naomi felt she could no longer bear testing her blood sugar levels many times each day to calculate how much insulin she needed to inject, even though she knew she was risking her long-term health and putting herself in extreme danger, at risk of developing diabetic ketoacidosis (DKA), which can lead to a coma. She became so ill she was admitted to an eating disorder unit even though she was not struggling to eat. The head of the unit, Dr Carla Figueirdo, says of her diabetes patients: "These people are seriously unwell, seriously unwell. They are putting themselves at harm every day of their lives if they don't take their insulin." Naomi's consultant at the Royal Bournemouth Hospital, Dr Helen Partridge, says the psychological impact of a diabetes diagnosis should not be underestimated. The hospital is hosting one of two NHS England pilot projects looking at how to treat type 1 diabetes patients whose chronic illness affects their mental health. NHS England diabetes lead Prof Partha Kar says: "The NHS long-term plan commits strongly on getting mental and physical health together. If we do tackle these two together, it will help improve outcomes." Read full story Source: BBC News, 16 November 2020 -
News ArticleTens of thousands of people avoided going to hospital for life-threatening illnesses such as heart attacks during Britain's coronavirus crisis, data has revealed. Shocking figures reveal that admissions for seven deadly non-coronavirus conditions between March and June fell by more than 173,000 on the previous year. Previous data for England shows there were nearly 6,000 fewer admissions for heart attacks in March and April compared with last year, and almost 137,000 fewer cancer admissions from March to June. Analysis by the Daily Mail found that the trends were alarmingly similar across the board for patients who suffered strokes, diabetes, dementia, mental health conditions and eating disorders. Health experts said the statistics were 'troubling' and warned that many patients may have died or suffered longterm harm as a result. Gbemi Babalola, senior analyst at the King's Fund think-tank said: "People with some of the most serious health concerns are going without the healthcare they desperately need. Compared with the height of the pandemic, the NHS is seeing an increase in the number of patients as services restart, and significant effort is going into new ways to treat and support patients." "But the fact remains that fewer people are being treated by NHS services." Read full story Source: Daily Mail, 13 September 2020
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News ArticleA concise training programme aimed at informing healthcare staff about diabetes has the potential to significantly improve patient safety, according to researchers. The programme, which was developed by the North West London Collaboration of Clinical Commissioning Groups, has been linked with a reduction in diabetes-related errors. The Diabetes 10 Point Training Programme was initially created with the aim of improving inpatient safety by ensuring frontline staff have access to diabetes training. Researchers from the CCG collaboration noted that the annual National Diabetes Inpatient Audit (NaDIA) had made for “grim reading with errors, harm, increased length of stay and mortality”. They highlighted that a workforce with knowledge of diabetes was “crucial to inpatient safety”, and said that complex diabetes care could be delivered by non-specialists with adequate training. Read full story Source: Nursing Times, 29 April. 2021
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News Article
'Anger' over report into neglect death care home
Patient Safety Learning posted a news article in News
The mother of a man who died after suffering neglect said she felt "extreme distress and anger" at a critical new report into his care home. James Delaney, 37, died while he was a resident at Sapphire House in Bradwell, Norfolk, in July 2018. After an inadequate rating by the Care Quality Commission (CQC), Mr Delaney's mother said she felt lessons had not been learned from her son's death. A spokeswoman for operator Crystal Care said it had "addressed all concerns". Mr Delaney, who died of a diabetes-related illness, was required to take insulin twice a day, but, despite staff noting he had not taken insulin for three days, they failed to take action. Jacqueline Lake, senior coroner for Norfolk, said at his inquest in 2019 there had been "a gross failure" by the care home to provide "basic medical attention". The home, which houses up to five people who have a learning disability or autistic spectrum disorder, was inspected in January and February 2021 after two whistleblowers alleged that abusive practices were taking place - a claim which is being investigated by the local safeguarding team. CQC inspectors found "people were not safe and were at risk of avoidable harm", and while risk assessments for diabetes, medicines and behaviour management existed, information was often "lacking or inaccurate". After reading the report, Mr Delaney's mother, Roberta Conway, said her reaction was one of "extreme distress and anger". She said the coroner had "pointed out what needed to be done, and it hasn't been done". "It cost my son his life and I don't want to see anybody else's life being wasted," she added. Read full story Source: BBC News, 21 April 2021 -
News Article
Doctors suggest COVID-19 could cause diabetes
Patient Safety Learning posted a news article in News
A cohort of scientists from across the world believe that there is a growing body of evidence that COVID-19 can cause diabetes in some patients. Prof Francesco Rubino, from King’s College London, is leading the call for a full investigation into a possible link between the two diseases. Having seen a rise in both type 1 and type 2 diabetes in people who have caught coronavirus, some doctors are even considering the possibility that the virus ‒ by disrupting sugar metabolism ‒ could be inducing an entirely new form of diabetes. Rubino and others set up a registry to start pooling and analysing reports of cases. The principal investigators of the registry which has received reports from more than 350 individual clinicians who suspect they have encountered one or more cases of Covid-induced diabetes — have said the numbers were hard to ignore. “Over the last few months, we’ve seen more cases of patients that had either developed diabetes during the Covid-19 experience, or shortly after that. We are now starting to think the link is probably true – there is an ability of the virus to cause a malfunctioning of sugar metabolism,” said Rubino. If there was a biological link, it would be difficult to prove without a substantial database, he noted. “We said it’s worth embarking on an investigation because this – especially given the size of the pandemic – could be a significant problem.” Read story Source: The Guardian, 19 March 2021 -
News Article
Type 1 diabetes and COVID-19 link being investigated
Patient Safety Learning posted a news article in News
A study is under way in the Southern Health Trust area to investigate possible links between Type 1 diabetes and COVID-19. A consultant paediatrician said there has been an increase in the number of young people being diagnosed since the beginning of the pandemic. Last year, the trust said there were 41 new cases, its highest yearly total on record. Dr Sarinda Millar specialises in Type 1 diabetes in children and young people. "We are having more diagnoses, specially since the start of 2021 but more last year, as well," she said. "...in January we had nine new cases of Type 1 diabetes in children and young people in one week alone in our trust area," she said. "In other years, we wouldn't even have had one every week. And regionally, we have all seen an increase in Type 1 diabetes which leads us to question is COVID-19 in some way related?" Because of the increase in Type 1 diabetes over the past year, the Southern Trust is commissioning fresh research on the matter. "It is quite a wide piece of research we are hoping to do," Dr Millar said. "As well as looking to see if these children have been exposed to Covid, looking at their antibody status, we also want to know what other implications COVID-19 has had. For example, have families delayed bringing their child to hospital? We have seen that children are presenting sicker." Read full story Source: BBC News, 8 March 2021 -
News Article
Covid: Confusion over gestational diabetes advice
Patient Safety Learning posted a news article in News
Some pregnant women who have had gestational diabetes say a change to shielding advice in England has caused confusion. Some have been told to stay at home while others have not, based on a new algorithm which calculates an individual's risk from Covid. It identified an extra 1.7 million people as extremely clinically vulnerable in England this week. They will now be prioritised for a Covid vaccine. NHS England says not everyone with the same condition will be advised to shield but suggests people contact their GP to discuss their individual case. Heather Davis Mahoney, from Hertfordshire, had gestational diabetes while carrying her second child, and was monitored closely during her third pregnancy. She has not been told to shield, but says it's worrying when others from similar backgrounds have been told they should. "There's been an explosion of confusion. People don't know what's going on and are worried about putting themselves and their babies at risk," she says. But GP Dr David Triska said just because someone has gestational diabetes or had it in the past, doesn't mean they should be shielding. "I think the major point of confusion is that people are expecting that this is a binary 'yes' or 'no' per condition algorithm - and it is not," he said. "The reason why people are getting different answers from various sources is because this is an individual risk assessment." Read full story Source: BBC News, 20 February 2021 -
News Article
Lessons learned after diabetic bled to death at Shropshire hospital
Patient Safety Learning posted a news article in News
The family of a man who bled to death during kidney dialysis treatment at Royal Shrewsbury Hospital have said they believe lessons have been learned. Mohammed Ismael Zaman, known as Bolly, died after hospital staff failed to check the connection on his dialysis machine, despite it sounding an alarm after the catheter had become disconnected. During Mr Zaman’s treatment at the Royal Shrewsbury Hospital on October 18, 2019, his dialysis machine set off a venous pressure alarm. An unidentified member of staff reset the alarm without checking that the connection was still secure. As a result of the reset, Mr Zaman bled out for seven minutes losing 49% of his blood circulating volume. He was found unconscious in a pool of blood and despite resuscitation attempts, died two hours later. The coroner, Mr John Ellery concluded that the death was due to systems failure and individual neglect on the part of the unidentified staff member. Read full story Source: Shropshire Star, 16 January 2021 -
News ArticleIt has been recommended by UK researchers that patients, regardless of their metabolic rate, should be given weight management advice as people with obesity were still at risk of diabetes, cardiovascular and respiratory diseases. A recent study found that regardless of your metabolic rate, it did not necessarily mean that the patient with obesity were healthy and that doctors should avoid using the term “metabolically healthy obesity” as it could be misleading. Read full story. Source: Nursing Times, 11 June 2021
