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Diabetes experts step up flu guidance

Doctors are urging NHS emergency planners not to underestimate the disruption to hospital and GP services caused by the impact of a flu epidemic among the UK's 2.4m diabetes patients.

As latest figures showed another rise in the number of swine and seasonal flu cases, the Association of British Clinical Diabetologists (ABCD) issued its latest guidance to both patients and local diabetes services to help them manage the risks posed by a potential pandemic.

As a shortage in seasonal flu vaccine continues to affect parts of the NHS, it called upon people with diabetes to be made the highest priority for vaccination.

The association said the UK's growing diabetic community were particularly at risk from the current outbreaks of swine and seasonal flu, with research showing they were six times more likely to be hospitalised as a result, compared to people without diabetes. Diabetes patients were also at significantly increased risk of excessive mortality and morbidity.

It fears that an acute influenza infection could result in a potential 10-fold increase in the number of urgent new insulin starts. “The impact of these risks, and the way they are managed both in hospitals and in primary care, needs expert assessment as part of contingency planning at a local level,” said ABCD Chairman Dr Peter Winocour.

“Emergency planners are doing a very good job in difficult circumstances - but diabetologists have an important part to play in working with them to identify, and minimise, the risks posed to diabetes patients, and the knock-on effects to the wider NHS. In a full-scale pandemic, hospital services could be stretched to, and even beyond, capacity. Many patients with diabetes will almost certainly need advice on medical management outside their usual care setting.”

He added: “Influenza, as with any infection, has the potential to aggravate diabetes, resulting in deteriorating blood glucose levels (hyperglycaemia) and a consequent classic vicious cycle, further impairing body defences to infection.”

ABCD is the national organisation representing more than 500 consultant physicians and registrars in Britain who specialise in diabetes mellitus - an increasingly common condition that affects an estimated 2.4 million people, although the actual figure is feared to be far higher.

In its plan for local diabetes services, ABCD is urging:

  • The launch of a local multidisciplinary team, across primary and secondary interfaces, to address contingency planning issues in the event of an influenza pandemic.
  • The roll-out of its "Be Prepared" education campaign, which provides patients and healthcare professionals with greater awareness and understanding of what to expect and what needs to be done.
  • A review of what routine clinical services should be suspended and what essential services need be safeguarded, as staff are redeployed to other areas and likely to suffer from greater levels of sickness themselves.
  • Better communications with patients with diabetes, as well as between healthcare professionals, as medical advice is likely to be required with some urgency. Primary care should have direct and speedy access to specialist diabetes advice, and an integration of care predominantly in the community is likely to be required.

As part of its advice to people with diabetes, ABCD said patient self-management with the support of local specialist diabetes expertise was the key to a successful outcome. Closer attention to diabetes control will be needed - in most cases by careful blood glucose self-monitoring and adjusting treatment as appropriate. In particular, insulin should not be stopped and often the dose may need to be temporarily increased.

It advises that patients should advise their GP by phone when suffering from influenza and be aware of serious symptoms - such as increased drowsiness, dehydration and respiratory distress - which may indicate urgent need for hospitalisation.

Association of British Clinical Diabetologists