The Big Interview – Dr Sarinda Millar
There are few Diabetes consultants out there who could regularly team up with top Tik Tok stars, but Dr Sarinda Millar does. In fact, it was the well-known influencer partnership the Diabetic Duo who introduced The Diabetes Times to Dr Millar, who has become well-known for her work within the sector of young people and transitional care.
Here she talks about all the changes she has introduced to help the move from paediatrics to adult services become easier and how COVID-19 may actually have had some benefits for young people with diabetes.
What is your job title?
I have a few. Joint Clinical Director Paediatrics Daisy Hill Hospital, Consultant Paediatrician, Lead for type 1 Diabetes for children and young people Southern Health and Social Care Trust and Lead for Paediatric feeding service.
How long have you worked in diabetes?
About seven years in current inter-professional type 1 Diabetes team.
From your perspective, what immediate impact has COVID-19 had on people with type 1 Diabetes?
Dr Sarinda Millar has done a lot of work in transitional services
I don’t think children and young people with type 1 Diabetes have been affected more than other children with the pandemic. I heard a psychologist recently suggest the extent to which children have been affected has been partly dependent on how their parents have managed.
As with other children, I think the lack of social interaction, recreational activities and routine, coupled with being taught by impatient and inexperienced parents (speaking from experience!) who were trying to work, as well as home school, has been challenging and difficult on all young people.
Some of our families found managing their child’s type 1 Diabetes easier as their kids were with them more and they were able to help with their diabetes management more. Also, the lack of sporting activities and social outings has made type 1 diabetes management more predictable to some extent.
Another positive I think from lockdown is that it has encouraged families to focus more on technology and many have actively begun to review their child’s blood glucose levels more regularly. Overall they have become more confident in making changes.
On the other hand I know there were also families who were very anxious that their child was more at risk and many sought reassurance from the team over the course of the lockdown.
Tell us more about the study you are leading in the Southern Health Trust about type 1 Diabetes and COVID-19.
Our study is exploring the impact COVID-19 has had on newly diagnosed patients and their families. We are particularly interested to see if families delayed seeking medical assessment due to fear of entering healthcare facilities, which has led to children and young people presently more unwell.
We also want to know the impact the pandemic has had on newly diagnosed patients with regards to their initial and ongoing education and building relationships with the Diabetes team.
Another arm to the study is to explore how the team itself was affected as working practices changes so much for them.
Tell us about the one-stop health and information clinic for young people aged 16-20 with type 1 diabetes that you run
The Southern Health and Social Care Trust developed a young adult’s type 1 diabetes service several years ago. This is a service for 16-20 year olds delivered by both paediatric and adult diabetes inter-professional teams.
As is well documented, this is an extremely vulnerable age group. We want to offer flexibility and be responsive to the emotional and psychological needs of this group as well as their medical needs. Our aim was to reduce the burden of the many appointments required for these young people, such as annual retinal screenings and foot examinations and combine them all into one appointment.
Traditional multidisciplinary clinics offer little peer support, despite young people sitting in the waiting area together. We decided to replace one of the mandatory three-monthly appointments with one single event. We first trialled this in June 2018 and then re ran it a year later, incorporating feedback we had received from the previous year.
The event involved inviting all our 16-20 year olds to a venue outside of the hospital setting at the same time. Lunch was provided by a lady with type 1 Diabetes who had set up her own business. She gave a talk on how she went about this.
We invited experts in driving, sexual health, alcohol, drugs, smoking, exercise and travel to provide specific advice on their subject. We tried to make the information relevant and accessible for the young people all under one roof.
The retinal screening service and podiatrists were there to complete annual checks. Adult and paediatric medical team, diabetes specialist nurses, diabetes specialist dietitians and psychologists were available for consultation or informal chat.
The afternoon was very much directed by the young person in that they could speak with whoever they wanted and seek information applicable to their needs.
What are the main issues with transitional care for diabetes and how could these changes be dealt with?
We are very fortunate in the SHSCT that our Children and Young people services have allowed us to invest time and inter-professional staff into our transition clinic. This has given our young adults a safe space to allow them to become more independent.
Our Trust understands what a daunting step it is to move from paediatric to adult services and have encouraged us to put a real emphasis on developing and continually trying to improve our young adult’s service.
We understand transition happens at different times and stages for each individual and we endeavour to provide a flexible and reactive service for our young people.
We try to involve our young people so they too can help develop their service and have a say in it. We actively listen to what they want and we think we now understand that different young people want and need different things.
Dr Millar has worked with the Diabetic Duo to help raise diabetes awareness
We also understand it can be difficult for some parents too and we aim to provide them with support so they feel more comfortable about allowing their child to have more independence.
Unfortunately, adult services on the whole are stretched but we are delighted to have an innovative and forward-thinking adult physician as part of our team, Dr P McMullan. He has a strong interest in technology and diabetes and sports and has been instrumental in helping us develop our service. He can pull together and showcase data and use this to ensure we are meeting key processes in diabetes care.
Our DSNs and DSDs (adult and paediatric) are invaluable links for our young people as they provide the ongoing support and advice in between clinics. They really are key for continuity of care within our clinic and again we have a really enthusiastic team.
The main issue we have found is the resistance that many of our young people have when it comes to getting involved with our psychology team. We are overjoyed to have increased psychology services within our Children’s services. The psychology team provide so many different forms of intervention depending on the need of the person….it is definitely not a ‘one size fits all’ approach. Despite this, lots of young people and their families just won’t engage. This is such a shame as living with a chronic condition is challenging for anyone.
What impact will COVID-19 have on the long-term management of diabetes post pandemic?
Hopefully young people and their families will continue to engage more with technology. Reviewing blood glucose readings regularly is vital. We want to help families as much as possible so they feel more empowered to make changes as appropriate.
There have been some positives as in remote education has made it possible for families and staff to meet without the hassle of parking, getting other children looked after and taking time off work or school.
Professionals can access meetings and education events more easily and this is crucial because learning from others is of paramount importance when continually reviewing and developing services.
I think virtual consultations and education are here to stay, but they can never fully replace face-to-face consultations. We certainly enjoy and look forward to seeing our children and young people. Face to face appointments are more conducive to building strong, supportive relationships with our families.
How has seeing patients remotely impacted care?
For some families this has worked very well. It is more convenient for them in many ways. On the majority of occasions remote appointments are conducted with parents when the child is at school. In some ways this saves time out of education which has been important this year with school being off for so long but in other ways it felt like we weren’t engaging with or supporting the child/young person at all.
For others who struggle with technology or perhaps need more support it is not as effective. As with most things it has its pros and cons.
It does feel less personal on the other end of a telephone or video call but for those families we know well and who are motivated and engaging it has had huge benefits.
Do you think the landscape for treating people, particularly children with diabetes, has changed permanently and if so, why?
For some yes but for the majority of our patients I think, both the team and the families, prefer to have face to face meetings. They are more personal.
For some of the young adults it is better to have virtual contacts, than no contact at all, so we will continue to offer choice to all our families in the future as usual.
It has certainly highlighted the important role technology plays in type 1 diabetes care and hopefully this heightened engagement families have with reviewing their data at home with continue.
The Diabetic Duo have been become popular on Tik Tok, how has the Trust become involved with them and why?
We recognise the impact of living with a long-term condition can have on young people and as mentioned the reluctance to engage with psychology as well as limited psychological services available in some areas.
We also recognise the importance of peer support and when I heard of the positive message the Diabetic Duo were getting out there I was genuinely very excited.
The girls are so approachable and willing to support and help others who are having difficulties. They know the challenges first-hand and have overcome them or have learned to deal with them in their day to day lives so they are the experts.
They are on our local charity committee T1DCAT (Type 1 diabetes Children and Teenagers). We set up this charity several years ago for our families to offer peer support. We usually have regular events for our families and young people ranging from social Christmas parties to pamper and gaming nights.
Obviously COVID-19 has restricted us in what we can do, but the Diabetic Duo have been so helpful. Together they’ve run some zoom sessions for our younger patients and have offered so much encouragement. I know many young people who have benefited so much by simply just meeting with them.
Both of them are great role models in the way they live their lives to the full, not letting type 1 diabetes stop them from doing anything. They are brilliant at getting the message out there about type 1 Diabetes and they don’t try to hide the fact they have it.
The diabetic duo and myself were recently on the BBC news on television and radio raising awareness of our recent increase in numbers of children presenting with type 1 Diabetes and to educate the public on the signs and symptoms to look for.
The Diabetic Duo themselves have done many interviews, again getting the message out there that type 1 Diabetes is an autoimmune condition and that it is in no way related to lifestyle or diet. There is nothing you can do to prevent someone from getting it.
What do you do in your spare time?
I am married to an anaesthetist and we have three boys who I enjoy watching playing their various sporting activities.
I enjoy running, walking and Caroline Girvan’s EPIC workouts.
I love baking and entertaining although I think it has been a positive for my husband during lockdown that we are not allowed visitors!!
I am actively involved in a charity called Hope and Light Jewellery. Its greatest goal is to raise awareness of the huge problem of human trafficking and demonstrate how we can work together to end it.