Nicola Milne

Audit within Brooklands and Northenden Primary Care Network revealed that people with type 2 diabetes under the age of 50 years were an underserved population and were less likely to receive the recommended eight care processes than other age groups locally. This article outlines the initiatives carried out to address this inequality. The  work involved a Diabetes Support Team (DiaST) model of care and embedded an array of actions to overcome barriers to engagement among this hardly reached group. The initiative has resulted in more than a doubling of the rate of care process achievement in this population, although disparities with other age groups remain. The article should serve as inspiration for services looking to make the most of NHS England’s T2Day (Type 2 Diabetes in the Young) programme to fund extended health checks for people aged 18–39 years living with type 2 diabetes.

Citation: Milne N (2023) Engaging with and optimising care for people under age 50 years with type 2 diabetes: The DiaST model of care. Diabetes & Primary Care 25: [Early view publication]

Key words

– Audit

– DiaST

– Early-onset type 2 diabetes

– Service delivery

Author

Nicola Milne, DiaST Lead, Brooklands and Northenden PCN.

Background: The management of leg ulceration through compression has predominately been considered a community care need. In 2021, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust, in partnership with the Doncaster Wound Care Alliance, developed and launched a framework of interventions including education, a joint wound care formulary and clinical pathways, all aimed at standardising care. Additionally, they introduced the UrgoKTwo multicomponent compression system to provide seamless care across community, primary and secondary care using the National Wound Care Strategy Programme's (NWCSP) 2020 lower limb recommendations. As a result of changes implemented by the Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust,within secondary care, the knowledge of hospital staff increased by an average of 34% following attendance at structured education programmes, with 99% of staff being assessed as competent in the practical application of UrgoKTwo multicomponent compression bandage system. These improvements allowed the Skin Integrity Team to perform timely assessments, diagnoses and treatments for venous leg ulcers (VLUs), resulting in 89% of VLUs commencing UrgoKTwo multicomponent compression bandage system while patients were in the hospital and achieved healing within 12 months.

KEY WORDS

Education Healing rates Leg ulcers Lower limb UrgoKTwo

KELLY PHILLIPS Lead Nurse, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust, FRAN MCNAB Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

KATIE PHILLIPS Acting Clinical Nurse Specialist, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

TONI PLUMB Specialist Sister, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

LOUISE WALL Specialist Sister, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

VICTORIA DODD Specialist Sister, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

GEMMA LONG Specialist Support Worker, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

ENIKKA BARNES Specialist Support Worker, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

关键词：深度烧伤;临床研究;皮片移植

Imogen Stamford

Research has shown that use of continuous glucose monitoring (CGM) is associated with improved time in range, improved HbA1c, and decreased risk of long-term complications secondary to type 1 diabetes. There are, however, several barriers that can lead to discontinuation of CGM, including pain, skin reactions, concerns around accuracy, sensor loss, interference with daily activity, and alarm fatigue. This review paper will outline the impact of decision fatigue and alarm fatigue in children and young people using CGM.

Citation: Stamford I (2022) CGM for children and young people with type 1 diabetes: NICE criteria and effects of decision fatigue and alarm fatigue. for Children & Young People Diabetes Care 12: [Early view publication]

Article points

1. While the advantages of continuous glucose monitoring (CGM) are well recognised, as practitioners it is important to be aware of the implications of CGM use.

2. People with diabetes can never have a day without checking and responding to ever-changing glucose levels, which puts them at an increased risk of developing decision fatigue.

3. It is important for practitioners to support patients in creating balance between setting alarm limits that are narrow enough to ensure patient safety, but not so narrow that alarms will be repeatedly triggered can lead to the risk of alarms being ignored.

Key words

- Alarm fatigue

- Continuous glucose monitoring

- Decision fatigue

- Type 1 diabetes

Author

Imogen Stamford, Paediatric Diabetes Specialist Nurse, Oxford University Hospitals NHS Foundation Trust