Summary
Diabetes is a condition where glucose can’t get into your cells properly, so it begins to build up in your blood. This happens because something has gone wrong with the hormone insulin, which would normally allow the glucose in our blood to enter our cells.
Diabetes is mainly categorised as either type 1 or type 2:
- Type 1: you can’t make insulin at all
- Type 2: you can make insulin, but it either can’t work correctly or you can’t produce enough of it
Other types of diabetes include gestational diabetes (which some women develop during pregnancy), and some rarer types such as type 3c.
Care pathway
This pathway is designed to assess how well diabetic patients are managing their condition, and to make sure it does not lead to any other health problems such as hypertension or kidney damage.
1️⃣ Book the appointment
- We are using a combination of platforms / tools / teams to book patients in correctly with minimal manual effort. If @Louis Williams hasn’t already been in touch, check out the page to find our Monthly Summary plans or reach out to him to find out what you should be doing:
- If we’re using Hippo Labs, log into app.hippolabs.co.uk to find patient lists (see for more information)
- If we’re using Hero Health or AccuRX, @Louis Williams will send your team manual excel recall lists
- Call the patient to book the relevant appointment as instructed by the recall list (usually a double appointment F2F with an HCA, nursing associate or nurse)
You can book an appointment with any member of the nursing team, depending on availability and level of expertise of the nursing staff at your surgery
Explain what the appointment is for, advise them that they’ll have a blood test on the day, and that they must produce a fresh urine sample on the day of their appointment
2️⃣ Patient arrives for appointment
- Record that the patient has arrived in the appointment book
- Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
3️⃣ Carry out review
- Open the clinical template: ‘Penrose Health - Diabetes’ on EMIS
- Check the 8 key care processes (HbA1c, BP, cholesterol, serum creatinine, urine ACR, foot check, BMI, smoking status) and complete the template
- Make appropriate referrals
If a patient has had a new Diabetes diagnosis in the last 9 months make sure they have had a referral to the Structured Education Programme!
4️⃣ Check & triage results
- Review pathology results, and action as per the Lab Reports (Path Links) page. If, according to this page, a follow-up appointment is required, progress to step five below.
5️⃣ Follow-up appointment
- Discuss treatment plan with patient, based on the SE London Glycaemic Control Management Pathway and guidance below:
- For HbA1c, target <58mmol/mol (<7.5%). Target <64mmol/mol for moderately frail or dependent patients. Target <69mmol/mol (<8.5%) for severely frail or dementia patients.
- For cholesterol, prescribe statin if QRISK2>10%
- Please check QOF rules DM006, DM022, DM023 regarding prescribing of statins and ACE-I (or ARB) to relevant patients
- DM006 asks that Diabetic patients with a diagnosis of nephropathy or micro-albuminuria → treated with an ACE-I (or ARB)
- DM022 asks that Diabetic patients ≥40yrs, with no history of CVD, with low/no frailty → treated with a statin (unless CVD risk score <10% and type-2)
- DM023 asks that Diabetic patients with a history of CVD (excl. haemorrhagic stroke) → treated with a statin
For a list of suitable glucometers, please see: SEL-SMBG-Guidance-June-2024-for-consultation.pdf
- If blood pressure measurements are off-target according to the Hypertension Guidance for Primary Care in South East London, a follow-up will be needed as this could be an indicator of Hypertension
- If the patient is a smoker, a follow-up is required as they may have Peripheral arterial disease (PAD)