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Diabetes care in Southall 1982-2005

Diabetes care in Southall 1982-2005. Hugh Mather. What really matters in (type 2) diabetes ?? - in one slide…. Main threat is heart disease (and strokes) - causes 70-80% of deaths - more imp than eyes / kidneys / feet ‘Not’ reduced by glucose control /insulin etc

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Diabetes care in Southall 1982-2005

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  1. Diabetes care in Southall 1982-2005 Hugh Mather

  2. What really matters in (type 2) diabetes ??- in one slide… • Main threat is heart disease (and strokes)- causes 70-80% of deaths - more imp than eyes / kidneys / feet • ‘Not’ reduced by glucose control /insulin etc • Yet can now reduce it by 50% or more !!!! By taking statins to lower cholesterol, BP drugs & stopping smoking & taking aspirin – exciting ! • But difficult to persuade patients to take tablets ! • So diabetes care complicated … not just ‘glucose’

  3. Southall Diabetes Survey 1984 • Door-to-door survey – prevalence of known DM • 65,000 population – 18000 homes – 30 volunteers • Diabetes x 4 (400%) in Asian community – x 5-10 as common in people age 50-80 • First demonstration in UK • - not previously known !! • Thus a huge local issue

  4. Diabetes in Southall (continued) • Follow-up survey 1995 Asian diabetes patients more complications (esp heart disease) in Asians • Cause ? Genetics (affects Asians everywhere)exacerbated by weight & lack of exercise • Population age structure – very young in 1984now many more middle-aged and elderly- more and more patients & problems..

  5. How to respond to the challenge ?- 20 years’ experience… • Nurse-led clinics – established in 1985- run by diabetes specialist nurses - the key personnel – highly skilled…- revolutionary at the time ! • 2 clinics initially – now 30 practices6 diabetes specialist nurses – funded jointly - close collaboration with EHHHA & now PCT- including most practices in Southall- run jointly with practice nurses and GPs

  6. Our current strategy • Initial care in the community –GPs & practice nurses (& DSNs in most practices) • Referral to hospital if problems - poor control (? Insulin injections needed ) or complications • Local consensus guidelines for diabetes care- so standard policies re treatment • Ready access to hospital services if problems…

  7. Current balance between hospital and community care… • About 3000 patients attend Ealing Hospital- out of ? 10,000 patients (incl Ealing, Greenford)- referred because problems either complications (kidney/heart/nerves etc)or poor control - ? For insulin treatment • Seen annually – or 18 months/2 years…Joint care with primary care – Strategy not tactics – not fine tuning…

  8. Problems with the hospital service • More and more patients – unique ethnic mix increasing problems & complicationsConsultations at hospital rushed – not ideal • Hospital staff reduced - new doctors hours • Can only see patients infrequently… • Solution - ? Diabetes centre Regular small clinics throughout the week ??Working towards this….

  9. Discharging patients from hospital to community ? • Ultimate goal – strengthen community clinics • Relieve pressure on hospital service so can give better service to more needy patients • Actually quite difficult ! Old friends….Still want to come !

  10. Current ‘political’ drivers for change… • NSF – see elsewhere- good initiative – but no extra money • NICE guidelines – to standardize treatments nationally • GMS contract – huge spur to better treatment in primary care – targets for control etc

  11. Current initiatives to improve community care… • Warwick course – intensive education • Educational programmes for practice nurses… • Eye screening initiatives • Group education sessions – different languages …

  12. Summary • Local situation dominated by unique ethnic mix- vastly increased numbers of at-risk patients… • Huge potential for good – especially with modern treatments to decrease heart disease • Current balance between hospital and primary carewith key role of diabetes specialist nurses • Changes ahead – we need to improve… • Exciting prospects – but need more resources etc Emphasis on reduction of heart disease …

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