Managing Diabetes at Home – the New Normal

Managing people with diabetes to prevent complications and health deterioration has long been a priority for the NHS¹. The cost of treating diabetes accounts for 10% of the annual budget and continues to escalate².

With 18% of all hospital beds being taken up by people with diabetes³, we need to find new ways of working to ensure that patients are well managed at home, supported if discharged from hospital and hospital admissions are avoided.

By Angelina Thorne on May 5, 2020

Diabetes and COVID-19

COVID-19 has presented the healthcare community with new challenges but also opportunities for changing the pathways to support our vulnerable patients in both the acute and community setting.

People with diabetes fall into the high-risk category for contracting COVID-19⁴, and those infected are at a greater risk of developing emergency states of hyperglycaemia with ketones, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS).

New guidelines have been developed across the healthcare system, including care homes, to support healthcare workers in recognising complications and provide guidance on treatment pathways³.

Keeping Patients Healthy

It’s essential that people with diabetes, including newly diagnosed patients, continue to exercise proper diabetes management and check their blood glucose levels regularly. Coronavirus can cause difficulties in managing diabetes, potentially leading to DKA, meaning people with diabetes are particularly vulnerable to becoming seriously ill with COVID-19.

Patients may benefit from monitoring blood ketones to spot the early signs of developing DKA. General guidance is less than 0.6 mmol/L is safe and blood ketones above 1.5, presenting an increased DKA risk.

By supporting patients to understand better how to measure their blood ketone levels, we can continue to ensure the proper management of patients with diabetes while protecting resources for the response to coronavirus.

How to Improve Diabetes Management

How to improve managing diabetes at home

Monitor blood ketone levels at home and in care home settings. This is particularly important for patients with type 1 diabetes.
Group face-to-face patient education is on hold to protect patients and healthcare workers. Consider using online options that are delivered by trained educators via a virtual clinic.
In these difficult times, we need to protect the vulnerable. People with diabetes fall into the high-risk category and should avoid visiting the pharmacy. However, it is vital that medicine adherence is continued throughout the pandemic. Using an online pharmacy, such as Spirit Pharmacy, is an easy and more reliable way for diabetes patients to get their prescription items. Spirit Pharmacy has a special interest in diabetes and provides patients with access to educational support.
Utilise remote monitoring where appropriate. This can include using video and telephone consultations, tracking patient vital signs and general health and wellbeing.

Spirit response – a platform for future care

Blood Ketone Awareness and Support

We are supporting CCGs and patients by making the CareSens Dual meter, which tests for both glucose and ketones, more accessible.

CareSens Dual blood glucose meter

We are supplying GP practices with additional stocks of meters and patients can contact us directly to request a free meter, which is then posted to their home. We include a range of patient leaflets to support and advise patients on why they should test for ketones and how to interpret results. Patients can also watch a demo video of the CareSens Dual meter or call our 24/7 freephone number to speak to someone to help with their meter.

Spirit Implement offers a programme of primary care support to reduce non-elective admissions due to DKA.

Meter and support for practices:

CareSens Dual devices
Quality Assurance Programme
HCP Training
Implementation of DKA patient pathways

Support for at-risk patients:

Auditing services to identify patients at risk of DKA
Virtual training sessions for blood glucose and ketone testing
Patient support materials

Virtual Education Clinics

Diabetes education is recommended for all newly diagnosed patients. With group face-to-face programmes suspended until further notice, Spirit has moved its national QISMET accredited EMPOWER programme for patients with type 2 diabetes online. EMPOWER has gone virtual, with online courses delivered by our educators to small groups of patients in the comfort and safety of their own home.

Virtual EMPOWER structured diabetes education helps managing diabetes at home

Commissioners of our service have welcomed the move to ensure that patients receive the support and guidance they need, and feedback from people attending the sessions have been positive.

Prescription Support

Spirit Pharmacy is supporting people with diabetes by making free prescription deliveries to patients’ homes and providing additional diabetes support to help isolating patients. Spirit Pharmacy is a distance selling pharmacy with a special interest in diabetes. We provide the same dispensing services and advice you would expect from local community pharmacies, with the convenience of easy repeat prescription ordering to ensure medication adherence.

More than just medications

Specialist support from trained diabetes pharmacists, including medication reviews if required
Access to our FREE online education course to help patients learn about managing the condition as well as tracking tools that encourage long term behaviour change
Monthly eNewsletter to keep up-to-date with current guidance and helpful news
Regular blog posts that patients are finding particularly useful while isolating

Remote Monitoring

Digital, remote monitoring technology allows patients to be monitored by their care teams from the safety of their own homes, and care home residents to be appropriately assessed on a regular basis by their familiar carers. Digital solutions and video calls have enabled GPs to provide continuity of care while limiting how many patients they see in person during this pandemic.

CliniTouch Vie enables remote monitoring for vulnerable people with long term conditions and those discharged early, from the safety of their home, helping care teams to prioritise those most in need through vital sign monitoring.

We are working with trusts, community teams, care homes and GPs to support patients as a result of the pandemic. Read more about our work with Trusts and Care Homes.

CliniTouch Vie has a specific diabetes algorithm which can be personalised to individual patient needs and includes an education module.

Here to help!

Consideration of how to support patients during the COVID-19 pandemic is vital to help ease the pressure on hospital resources. Most of the actions could help change the long-term management of patients going forward.

References

NHS Long Term Plan, January 2019 https://www.longtermplan.nhs.uk/ accessed 29/04/20
Hex et al. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine (2012). Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2012.03698.x/abstract
Based on NHS ‘Clinical guide for the management of acute diabetes during the coronavirus pandemic’ ref 001559. https://abcd.care/maintaining-and-delivering-diabetes-services-during-covid-19-pandemic accessed 30/04/20

Maintaining acute diabetes services in response to COVID-19

Speciality template for acute diabetes services

Concise advice on Inpatient Diabetes (COVID:Diabetes) – Front Door Guidance

Concise adVice on Inpatient Diabetes – Guidelines for managing DKA using subcutaneous insulin

Concise advice on Inpatient Diabetes – Guidance for managing inpatient hyperglycaemia

A Covid-19 Response Action – Diabetes Management in Care Homes