‘New approach needed’ for inpatients with diabetes

The NHS must take immediate action to raise standards of care in hospitals for people with diabetes, according to the UK’s leading specialist in diabetes inpatient care.

Dr Gerry Rayman, Head of Service at the Diabetes Centre, Ipswich Hospital NHS Trust, lead for the National Diabetes Inpatient Audit and specialist medical advisor to Diabetes UK, has advised that a new approach is needed to tackle the often poor care that people with diabetes – who account for about one in six of all inpatients – receive in hospital and to address the almost 8-10 per cent higher mortality rate among inpatients with diabetes.

Leading discussions on inpatient care at Diabetes UK’s Professional Conference this week, Dr Rayman said that hospital management teams and diabetes specialist teams must work together to implement hospital-wide safety practices.

This approach, which is already taken by hospital management teams and specialist teams for conditions including stroke, prevention of Venous-Thromboembolic disease, and hospital infection, would ensure much safer care for people with diabetes when they are admitted to hospital, reduce the length of their hospital stays, and bring about considerable financial savings.

There has been some improvements in care over the last few years but there is still a long way to go, according to Diabetes UK. One in five people with diabetes in hospital experiences their blood glucose levels falling dangerously low, 37 per cent experience medication errors, and cases of diabetic ketoacidosis, an entirely preventable life-threatening condition, have not reduced.

This in turn leads to longer hospital stays, further illness, greater financial expenditure on services, and ultimately contributes to the higher mortality rate among inpatients with diabetes. Studies evidence the benefits of coordinated inpatient diabetes services led by specialist teams both for patients and for NHS budget; teams taking this approach reduce their annual costs by three times. It’s clear on every level that this approach must be adopted.

Dr Rayman said: “Patients with diabetes are still not consistently getting the level of care they need and there are many occasions when their health is being put at risk as a result. Too few hospitals have fully-staffed inpatient diabetes teams, and over 30 per cent of hospitals do not even have an inpatient diabetes specialist nurse.

Patients with diabetes are still not consistently getting the level of care they need and there are many occasions when their health is being put at risk as a result

“We need a commitment and a concerted effort made now, across all hospitals, driven forward by hospital leaders including both managers and clinicians, to provide a high level of care for inpatients with diabetes.

“It is clear this will be cost effective. We are falling behind many ‘first world health’ countries who, for example, achieve better glucose control using more advanced insulin treatments regimens as standard care for all patients admitted to hospital with diabetes. At present this is not possible in the UK because we do not have enough inpatient specialists to safely implement these more complex treatments.”

Barbara Young, Chief Executive of Diabetes UK, said: “Though there have been some improvements in inpatient care over the last few years, there is still a long way to go before people with diabetes routinely get the care they need when they come into hospital. Many hospital teams give brilliant care, but there are still too many people with diabetes whose health is put at risk as a direct result of sub-standard care in hospitals, including if they are admitted for a condition other than their diabetes.

“Specialist inpatient diabetes teams play a crucial role in providing care for people with very complex and difficult to manage diabetes, but also in delivering essential education and support to all hospital healthcare professionals to ensure very basic things happen. This includes things like working with general ward nurses and healthcare assistants to ensure that patients: are supported to monitor their blood glucose levels, have their feet checked every day for ulcers, and have meals that are suitable and given at the right times to ensure good glucose control.

“Without the support and oversight of these teams these basics do not happen which can result in poor diabetes control and other illnesses among patients which can prolong their hospital stay. In the worst cases, the results can be tragic, including foot problems resulting in amputation and unacceptably poor blood glucose management leading to coma, and in some cases even death.

“Inadequate inpatient care also burdens the NHS with huge and avoidable costs. These teams are essential. We want the NHS to take immediate action to make sure every hospital has a fully-staffed specialist inpatient diabetes team as this would be an important first step in ensuring people with diabetes are identified as soon as they are admitted and get the benefit of coordinated specialist input from diabetes experts, and would also relieve the NHS budget of avoidable costs.”