Analysis

Diabetes: what you need to know, whatever your setting

Its increasing prevalence and complexity mean all staff require core skills, say experts

Its increasing prevalence and complexity mean all staff require core skills, say experts


Support to self-manage is essential for preventing complications. Picture: iStock

An analysis by a leading diabetes charity lays bare the potentially devastating effects of the condition, especially when complications develop.

And because diabetes is becoming more widespread, experts say all nurses – not only specialists – will need to play a greater part in combating it.

Almost 3.7 million people in the UK have been diagnosed with diabetes but many more are thought to have the disease and the numbers are rising. 

Premature mortality

Using data from the NHS National Diabetes Audit, Diabetes UK has shown that in England and Wales 500 people living with diabetes die prematurely every week. People aged 35-64 with type 1 diabetes are up to four times more likely to die early than people without the disease.

Diabetes UK chief executive Chris Askew describes the figures as harrowing, adding: ‘The importance of helping people with diabetes avoid preventable complications, which can often lead to death, cannot be overstated.’

£972 million

is the minimum estimated NHS spend on diabetes-related foot ulceration and amputation in England in 2014-15 

Source: Diabetic Foot Care in England: An Economic Study

Type 2 diabetes is far more common than type 1 and is sometimes thought of as a 'milder' form. But as Diabetes UK points out, all diabetes is serious and if not controlled can have extremely serious effects, such as stroke and cardiovascular disease.

Each week in the UK, almost 700 people have a stroke as a complication of their diabetes and 530 have a diabetes-related heart attack. Other associated problems can also have a profound effect on people's lives. For example, diabetes is the leading cause of blindness in the UK’s working-age population.

But many of these complications are preventable if people are given the right support to manage their condition. 

‘Patient-facing staff in all settings need to understand diabetes, rather than think of it as a condition only commented on by a handful of specialists’

Ruth Miller, diabetes nurse consultant, NHS North West London Collaboration of Clinical Commissioning Groups

Diabetes UK head of care Dan Howarth, a clinical nurse specialist, says: ‘People living with diabetes who have been educated to understand their condition, and are supported to manage it effectively, will be more able to achieve better treatment outcomes and avoid potentially life-threatening complications.’

That means improving the training available to all nurses to increase their awareness so they are better equipped to identify diabetes-related problems as they arise.

‘It’s imperative that we all change the way we think about diabetes,’ says Ruth Miller, diabetes nurse consultant for NHS North West London Collaboration of Clinical Commissioning Groups and a finalist in the 2018 RCNi Nurse Awards.

‘Patient-facing staff in all settings need to understand and be knowledgeable about diabetes, rather than think of it as a condition that can only be commented on by a small handful of specialists.’

Mr Howarth, who has type 1 diabetes, agrees. ‘It’s so important nurses educate themselves about diabetes and know what checks people need to stay safe and ensure they are in control of their condition.’ 

To that end, Diabetes UK has developed a list of 15 ‘healthcare essentials’ designed to reduce the risk of serious complications.

What are the ‘healthcare essentials’?


Diabetes UK's Dan Howarth.

Diabetes UK’s ‘healthcare essentials’ are the 15 different checks and services that people with diabetes are entitled to receive and that can reduce the risk of serious complications.

‘Nurses should be aware of these and ensure people with diabetes have access to all of the checks they need to stay healthy,’ says Diabetes UK’s head of care Dan Howarth. 

The list includes the more obvious tests and checks, such as blood glucose, blood pressure and cholesterol, as well as useful information for patients on healthy kidneys, diet control, psychological support and group education courses.

The charity emphasises the importance of regular tests. NHS Digital says people with diabetes who have had regular annual checks have a mortality rate that is half that of those who have not

 

Counter the negative messages

Although all nurses can help patients manage their condition, Ms Miller stresses that the part played by specialists remains critical, especially in relation to supporting people with the psychological challenges of living with diabetes.

‘Apart from their practical and clinical support role, diabetes specialist nurses can also help address the guilt and self-blame that can be felt by people with diabetes,’ she says.

‘This is a complex long-term condition that can be stressful for some people. Some also develop depression, which isn’t helped by the many negative, punitive messages about diabetes in the media.’

Those negative messages may be exacerbated by healthcare professionals’ careless choice of words, says Mr Howarth. ‘The most simple and one of the most important things all nurses can do is to be careful with the language they use when speaking to people with diabetes,’ he says.

‘Language that is encouraging and doesn’t judge or stigmatise can help build up a patient’s confidence, reduce their anxiety and help them feel more in control of their condition.’

Treating type 2 diabetes alone costs the NHS nearly £9 billion a year, according to NHS England, and signs for the future are not encouraging. 

19,350

people a year in England and Wales experience stroke as a complication of type 2 diabetes

Source: National Diabetes Audit, 2015-16 

Type 2 diabetes in children and young adults

Analysis by Diabetes UK suggests that in England and Wales almost 7,000 children and young adults have type 2 diabetes – ten times the number reported when data were taken only from specialist units.

The charity found that in fact most young patients were being treated in primary care, underlining the need for staff in all settings to be alert to predisposing factors, especially obesity, and potential complications.

A third of children in England are overweight or obese by the time they leave primary school. If current trends continue, one in ten people will have diabetes by 2034, adding considerably to the 9% per cent of NHS spending that already goes towards the cost of treating the condition.

The impact of the disease is felt more keenly in some quarters than others, says Ms Miller. ‘Social deprivation is linked to very high rates of diabetes, complications and premature death,’ she says. ‘With this in mind, outreach work must be a key focus in the role of a diabetes specialist nurse in order to improve access to healthcare for hard-to-reach groups, the vulnerable and under-served populations.’

Among those populations are people with a serious mental illness, of whom 20% will develop diabetes, Ms Miller says. But up to 70% of those will be unaware they have the disease, ‘which is what can lead to complications and early death’. 

Management by non-specialists

She argues that as cases of diabetes increase, it is imperative that not only hospital and primary care staff understand the basics of the disease but also those in settings such as care homes, mental health and centres for homeless people.

In recognition of the fact that many of the most complex cases of diabetes are managed by non-specialists, Ms Miller developed the Diabetes 10-point Training Programme for staff in clinical settings. It aims to ensure all clinicians develop a core set of skills so they can provide safe, effective diabetes care.


Ruth Miller, centre, in a training session. Picture: Barney Newman

1 in 6

people in hospital have diabetes

Source: NHS England

‘The programme is a checklist of commonly seen errors and symptoms,’ Ms Miller says. ‘It helps staff to recognise when there is a problem and how to get the right help.’

Almost one in 20 prescriptions written by GPs in England relates to diabetes treatment, according to NHS Digital. The numbers reflect a doubling of the number of people diagnosed with the disease in the past decade.

Those prescriptions cost £1 billion a year but the human cost of the disease is incalculable, especially when complications set in. 

Ms Miller emphasises: ‘Staff need to be trained across health and social care to feel confident enough to provide people with diabetes with safe and high quality care.’

Read a full list of RCNi Learning modules on diabetes


Daniel Allen is a health journalist


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