Welcome to the Brent Intermediate Diabetes Care Services Launch - PowerPoint PPT Presentation

Slide1 l.jpg
1 / 57

Welcome to the Brent Intermediate Diabetes Care Services Launch. 10th May 2006 Clay Oven , Wembley. Brent Diabetes Services. Dr. Senan Devendra MD MRCP Consultant in Endocrinology & Integrated Diabetes Care Brent tPCT & Central Middlesex Hospital. The Team. Claire Lawler

Related searches for Welcome to the Brent Intermediate Diabetes Care Services Launch

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

Welcome to the Brent Intermediate Diabetes Care Services Launch

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Slide1 l.jpg

Welcome to the Brent Intermediate Diabetes Care Services Launch

10th May 2006

Clay Oven , Wembley

Brent diabetes services l.jpg

Brent Diabetes Services

Dr. Senan Devendra MD MRCP

Consultant in Endocrinology & Integrated Diabetes Care

Brent tPCT & Central Middlesex Hospital

The team l.jpg

The Team

  • Claire Lawler

  • Nina Patel, Julia Anthony & Lucy Ogida (DSN’s)

  • Sala Salih & Camelia Kirollos (Diabetes Edu. Network)

  • Salma Butt, Helen Davies & Farhat Hamid (dietetics)

  • Rakhee, Gaytree & E. Shillingford (podiatry)

  • Leena Sevak & Maggie McClelland (pathway managers)

  • Rowland Hughes (DPAG chair)

  • Silvia Sedeghian & G.Vafidis(retinal screening)

  • Ricky Banarsee & Azeem Majid (Imperial - research)

  • Kirsten Darylmple (Imperial – education faculty)

  • JKC – too many to mention

Slide4 l.jpg


Slide7 l.jpg

Diabetes SPA total referrals per locality (according to GP post code)20.02.06 – 26.04.06 total = 207 x £241= £50,000

Brent diabetes services8 l.jpg

Brent Diabetes Services

  • Clinical support: MDT approach

    - Intermediate care clinics

    - Email consultations

    - Liaising with District Nurses/out of hours

    - Up-skilling Primary Care colleagues

    - Telephone support clinics for patients

Brent diabetes services9 l.jpg

Brent Diabetes Services

  • Education: MDT approach

    - patient education

    - health care professional education

  • Research & Audit

Slide10 l.jpg

100 years of hormones

Photo Courtesy of Prof. G.Williams

Dean of Medicine, Univ. of Bristol

Expected standard of care microalbuminuria pathway l.jpg

Expected Standard of Care& Microalbuminuria Pathway

Dr Encarna Fernandez

Diabetes GPWSI – Kilburn Locality

Weight management in diabetes intermediate care l.jpg

Weight Management in Diabetes Intermediate Care

By Helen Davies & Salma Butt

Specialist Diabetes Dietitians

The business case l.jpg

The business case !

  • Type 2 DM – overweight at diagnosis

  • Av. BMI = 28-29

  • Relationship with macrovascular disease

  • Weight loss associated with survival

  • Does weight need to be managed “differently” in DM

Current services l.jpg

Current services

  • Diabetes education sessions

  • MDT intermediate care clinics

  • Fit for Life programme

  • Obesity clinic at Central Middx

Mdt intermediate care clinic l.jpg

MDT intermediate care clinic

  • Initial assessment

  • Readiness to change

  • Brent options

  • Refer to pathway

    (enclosed in conference pack)

Fit for life l.jpg

Fit for Life

  • 12 week weight management programme

  • Nutrition education + exercise

  • Group support

  • Referral through Diabetes SPA

Obesity clinic at cmh l.jpg

Obesity clinic at CMH

  • Patients with complications/poor control + maximum oral therapy

  • Failed at Intermediate care clinic

  • Intensive weight management advice

  • Long term support if necessary

  • Bariatric surgery

New package of care for improving glycaemic control in primary care l.jpg

New package of care for improving Glycaemic control in primary care

Nina Patel

DSN Brent tPCT

Slide21 l.jpg


  • To provide focused intensive input to improve HbA1c with a clear supportive plan and exit strategy

Referral criteria l.jpg

Referral criteria

  • Patient on maximum doses of oral hypoglycaemic

    (see protocol for the use of oral hypoglycaemic agents*)

  • HbA1c > 8 % (age < 75)


Where will the patient be seen l.jpg

Where will the patient be seen?

DSN clinic in own locality

  • KilburnKilburn Square clinic

  • WembleyWembleyWCHC

  • WillesdenWillesden CHC

  • KingsburyChalkhill Health Centre

  • HarlesdenMonks Park CHC

First review consultation 1 l.jpg

First Review – Consultation 1

  • Patient considered for education session

  • Medication review – address compliance

  • Dietetic assessment – weight management pathway

  • Assessment of motivation, health beliefs, readiness to change

  • Set realistic goals

  • Obtain a contract with agreed roles of DSN and patient (minimum 1.5% HbA1c reduction by 3 months)

  • Start Blood glucose monitoring

  • Insulin discussed or started

Consultation 2 2 to 3 wks post visit 1 l.jpg

Consultation 2:(2 to 3 wks post visit 1)

  • Assess blood glucose results

  • If not started, start insulin e.g. once daily long-acting or twice daily mix. Insulin

    (this can be done with practice nurse/ district nurse)

  • Given algorithm to follow

  • Address weight gain issue with insulin

    Titration of insulin doses over telephone with daily or weekly contact.

Consultation 3 4 to 6 weeks post visit 1 l.jpg

Weight check/ WC

Blood glucose control


Injection sites

Management of pen device.


Consider prandial insulin

Titration of insulin doses over telephone with daily or weekly contact.

Also consider


Weight management clinic

Exercise classes

Patient support group

Expert patient course

Consultation 3: (4 to 6 weeks post visit 1)

Consultation 4 3 month review l.jpg

Consultation 4: 3 month review

  • Check HbA1c (1 week before appointment)

  • Further titration of insulin

  • Add pre-meal soluble insulin

  • Check weight gain/WC & dietitian review

  • Titration of insulin doses over telephone with daily or weekly contact.

Exit strategy l.jpg

Exit strategy

  • Hba1c less than 7.5% (or desired goal achieved) return to the care of GP and Practice nurse.

  • Maintain regular contact (telephone of link DSN or Diabetes SPA given)

  • If HbA1c goal not achieved – consider other options (eg. restart package of care, JKC - insulin pump therapy, novel therapeutic agents)

Slide30 l.jpg

Joint British Societies Guidelines 2 on prevention of Cardiovascular Disease in Clinical Practice (JBS2):implications for Brent

Dr. Joan St John

Gpwsi Diabetes

Wembley Locality

Introduction l.jpg


  • How will the new guidelines affect the management of people with diabetes in Brent

  • What are the workforce and cost implications

  • What is the most effective way to implement the new guidelines ?

Jbs 2 2005 l.jpg

JBS – 2 2005

High risk patients

  • Established athero-sclerotic disease

  • 1ry prevention CVD risk >20%

  • Diabetics

    ALSO elevated risk due to a single risk factor

    BP >160/ >100 (or less if target organ damage)

    Elevated TC: HDL >6 or FH of hyperlipidaemia

Jbs 2 targets for high risk patients l.jpg

JBS-2 targets for high risk patients

Total cholesterol <4

(25% reduction)

LDL-cholesterol <2

(30% reduction)

Next steps l.jpg

Next Steps

  • What is the most effective way to implement the new guidelines ? In Primary care or Intermediary care

  • Guidelines for Titration of Simvastatin or

  • Trying to treat to target with one drug one visit

Highest risk group diabetes one of the following l.jpg

“Highest” Risk Group ( Diabetes + one of the following)

  • Previous CV event

  • Peripheral Vascular disease

  • Family history of Premature (<60yrs) death from IHD

  • Renal Impairment (eGFR < 60)

  • Micro-albuminuric patients

Treatment pathway for high risk group l.jpg

Treatment Pathway for High Risk Group


Start Simvastatin 20mg Start Atorvastatin 20mg (titrate to 80mg)

to 40mg if needed to achieve target or Rosuvastatin 10mg od


T. Cholesterol = 4

LDL = 2

Law, BMJ 2003

Slide39 l.jpg


Diabetes education network dr camelia kirollos associate specialist central middlesex hospital l.jpg

Diabetes Education


Dr Camelia Kirollos

Associate Specialist

Central Middlesex Hospital

* Please refer to handout for details

Brent diabetes education network l.jpg

Brent Diabetes Education Network

Diabetes education network l.jpg

Diabetes Education Network

  • Professionals’ Education

  • Nurses: Practice nurses, District nurses, Twilight nurses, Residential homes, Nursing Homes

  • Doctors: GPs, GPwSI, Hospital Doctors

  • Health care Assistants

Diabetes education network43 l.jpg

Diabetes Education Network

  • Patients’ Education

    Short courses - 2 days

    Long courses 6 weeks

    Tailored Ethnic or Cultural courses

    Eg. For Pakistani, Gujarati Communities

Attendants of diabetes patient education courses between july 2004 and march 2006 l.jpg

Attendants of diabetes patient education courses between July 2004 and March 2006

Total = 550

Patients self management courses l.jpg

Patients’ self-management courses

  • DAFNE: For Type 1 Diabetes (since 2002)

    Alternate Months at JKDC (CMH)

    Available soon in intermediate care

  • DESMOND: For newly diagnosed Type 2 Diabetes (NSF requirement)

Dafne improvement lasts l.jpg

DAFNE Improvement lasts




HbA1c (%)



Severe hypoglycemia

per 100 pt y












Years of follow-up

Certificate in diabetes care warwick courses l.jpg

Certificate in Diabetes Care: Warwick Courses

  • Warwick Diabetes care

    • Run twice a year: February and September

  • Includes 4 units (Each is a whole day)

    • Understanding Diabetes

    • Therapeutic Options

    • Preventing & Managing Complications

    • Life Times

Consultant led seminars l.jpg

Consultant led seminars

  • Insulin for life programme (Insulin initiation)

  • MERIT (Insulin initiation)

  • Consultant notes review service

    (eg. HbA1c >7.5%)

Educational needs l.jpg

Educational Needs

  • The network needs to extend and invite the front line workers:

    • Eg: Health care assistants

    • Twilight nurses

    • Pharmacist in the community and hospitals

    • Local initiatives for day release education.

    • Courses for Hospital staff.

    • Junior Doctors programmed trained.

Competency skills a mandatory requirement l.jpg

Competency & Skills“A Mandatory Requirement ”

Ram Dhillon FRCS

Consultant Surgeon, Northwick Park Hospital, Harrow

Hon. Professor, Middlesex University, London

National Clinical Lead, Elective Care Team

(m): 07 958 450 544

(e): ram.dhillon@talk21.com

No mans land locus of demand need for capacity competency skills l.jpg

2nd Opinion

No Mans Land(Locus of Demand & Need for Capacity, Competency & Skills)

No Mans Land

Intermediate Tier Level Care

Home to: (PwSIs) GPwSIs, NwSIs, AHPwSIs

What is fundamental for acquisition of competency skills l.jpg

What is Fundamentalfor Acquisition of Competency & Skills

  • Knowledge & Skills

  • Knowledge & Skills

  • Knowledge & Skills

  • Knowledge & Skills

    Adequate Training & Accreditation

Slide54 l.jpg

Clinical activity *

Local mentoring *

Directed learning *







Middlesex University, London

Royal College of General Practitioners (RCGP)

Clinical Case Studies *

Seminars #

(lectures, practical skills)



A Model for Competency/Skills Training & Accreditation in Respiratory Medicine for Primary Care ( Dr Vincent Mak & Prof. Ram Dhillon)

  • NB. Further details on Postgraduate Training for Special Interests : www.pgdip.com





Pwsis with special interests competent skilled potential effects l.jpg





Integrate 1*/2*


Clinical Pathways

Clinical Governance

Community Care

Cost-Effective Care

PwSIswithSpecial Interests ( competent & skilled)Potential effects

Questions l.jpg




  • Login