Diabetes specialist nurse Sarah Gregory offers practical advice on how to support patients with type 2 diabetes to regain control of their condition after the pandemic disruption
The priorities of diabetes care, support and management have been challenged in the past two years as a result of the Covid-19 pandemic, with ‘routine’ QOF annual reviews in England suspended for the year 2020/2021. This was in the context of increased workforce pressures and the need to prioritise clinical capacity, protect people with diabetes from potential harm related to face-to-face contact (required for venous blood testing and complete foot checks) and reduce non-urgent demand on pathology testing services.
- Recognise and address the impact Covid-19 had on diabetes management
- Understand how to prioritise patients’ needs
- Recognise ways to get key diabetes parameters and processes back on track
- Incorporate new NICE recommendations on medications
- Appreciate ways to reset reviews according to progress
Guidance published by the East of England Clinical Network on delivering diabetes care during the pandemic proved to be an excellent resource during this time, helping clinicians and services prioritise their patient contact.
We are now returning to some degree of ‘normal service’, but a significant number of people with diabetes have not had reviews or follow-ups, while newly diagnosed people may have been missed during the height of the pandemic.
Many providers will have seen a worsening of diabetes target achievement, and it is therefore important to take a slightly different approach when catching up on annual reviews.
Instead of simply looking at the nine key care processes and QOF, consider the following:
- Prioritise – consider what to focus on first, if individuals have multiple areas that need addressing or support with. Ask what is important to them, and what are their priorities?
- ‘Start from scratch’ – go back to basics when assessing key parameters such as HbA1c, blood pressure (BP), weight, blood and urinary albumin-creatinine ratio (ACR) and lipid profile.
- Assess adherence to medication – including checking when medications were last ordered, and asking about medication use, if the prescription does not match the frequency.
- Review lifestyle (diet, exercise, smoking) – have things changed in the last two years? What were the triggers? What positive things can you focus on?
- Review screening (feet, eyes) – have problems arisen during this time? Have they checked their feet or attended for eye screening?
- Support and help motivate – this may mean more reviews initially, but these may be done remotely in some cases.
- Consider new guidelines, particularly the recently updated NICE type 2 diabetes guidelines, which include changes to some glucose-lowering therapy recommendations.
The principles of management should be the same – joint target setting between the nurse and the person with diabetes. Engagement with individuals is key, and consultations should be collaborative and inclusive, not judgemental. Good use of language – verbal, written and non-verbal – can lower anxiety, build confidence and help to improve self-care.1
Sarah Gregory is Clinical Lead for Diabetes in Medway and Diabetes UK Clinical Champion
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