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Diabetes care: the case for group consultations



Imagine stepping down one person’s medication, only to see an improvement in another person’s blood sugars. This scenario does happen – in group consultations for people with diabetes.

Imagine stepping down one person’s medication, only to see an improvement in another person’s blood sugars. This scenario does happen – in group consultations for people with diabetes.

Across the UK we are seeing a rise in the numbers of people being diagnosed with type 2 diabetes. At the moment, 4.7 million people have type 2 diabetes and according to Diabetes UK, this fi gure is predicted to rise to 5.5 million by 2030.1 This rise will create additional pressures on general practice.  

In 2017, a nurse colleague and I implemented a pilot of diabetes group consultations to see if this format would ease our increasing time pressures.

Group consultations are, as their name suggests, group sessions, but unlike traditional diabetes support or education groups, they are facilitated by one-to-one clinical consultations in a peer group setting.

Type 2 diabetes is a complex disease to live with and manage and, as NICE states, ‘patient education and self-management are important aspects of care’.2 A large part of our role is to help patients understand their condition, make informed choices about their self-care and medication, and improve health literacy.

In the one-to-one consultations, general practice nurses (GPNs) may only have 20-30 minutes each year to achieve this. Our group consultations last approximately 90 minutes.

In our sessions a facilitator welcomes patients and explains the format and encourages them to think of questions to ask. The questions are often stimulated by the ‘numbers board’, which includes recent biometrics, such as HbA1c and blood pressure. After 20 minutes, I join the group for the next hour. I go through each patient’s questions and invite the group to help in answering them, enabling group members to support each other and share experiences.

I may also suggest medication changes, or refer to other clinicians, as with a one-to-one consultation.

Although our pilot is small, we have seen an average 10% drop in HbA1c.3 Other practices have also experienced HbA1c improvements. At Brigstock Medical Practice, for example, 73% of participants had some level of reduction in HbA1c.4

My initial motive for starting group consultations was to look at reducing time pressures, which was realised.3 The Brigstock Medical Practice results dramatically show the potential for time savings, as they have had remarkable effi ciency gains of 75%, achieved by having two group consultations a week for people with diabetes.4

As a GPN specialising in caring for people with type 2 diabetes, I have found group consultations to be a positive addition. The patients are more relaxed, the group consultations help reduce repetition of information and patients say they enjoy them. Patients say they have improved their knowledge, and some feel more socially connected, and confi dent to self manage.

What happens in group consultations

During group consultations we highlight issues of health literacy. Questions asked include:

  • What is a HbA1c?
  • What is a carbohydrate?
  • How do I reduce portion sizes?

In group consultations, patients set the agenda through their questions, and they learn from listening to their peers with clinician input.

One notable success was when stepping down one person’s medication helped another person improve their blood sugars. A person with type 2 diabetes had a raised HbA1c, and was being treated with multiple hypoglycaemic agents and injectables under secondary care. Within two weeks of attending the group consultation, their blood sugars had dropped by 4-5mmol/l. I asked them what had changed, and they said that listening to another person’s account of lifestyle changes (where I stepped down medication during the group consultation), led them to make lifestyle changes which improved their own blood sugars.

I recommend the group consultation model for reviewing people who have diabetes. As one participant said: ‘We can support each other’.

Catherine Whitrow is a general practice nurse at West Gorton Medical Centre in Manchester

References

  1. Diabetes UK. Number of people with diabetes reaches 4.7 million. Feb 2019. diabetes.org.uk/about_us/ news/new-stats-people-livingwith-diabetes
  2. NICE. Type 2 diabetes in adults: management. NG28 nice.org.uk/guidance/ng28/ chapter/Introduction
  3. NHS England. The Atlas of Shared Learning: Introducing group consultations for adults with type 2 diabetes. Feb 2019. england.nhs.uk/atlas_ case_study/introducinggroup-consultations-foradults-with-type-2-diabetes/
  4. Gandhi D, Craig G. An evaluation of the suitability, feasibility and acceptability of group consultations in Brigstock Medical Practice. Journal of Medicines Optimisation 2019;5:39-44