Clinical update
Diabetes Find out more
SPL
Essential facts Type 1 and type 2 diabetes affect 3.2 million people in the UK. Diabetes is associated with serious complications, including heart disease and stroke, which can lead to disability and premature death. It is the leading cause of preventable sight loss in people of working age in the UK. A quarter of people with diabetes will have kidney disease at some point in their lives, and the condition increases the risk of amputation. Good diabetes management has been shown to reduce the incidence of these serious complications.
NICE diabetes care pathway pathways.nice.org.uk/ pathways/diabetes Diabetes UK 15 Healthcare Essentials www.diabetes.org. uk/Guide-to-diabetes/ Monitoring/15-healthcareessentials
What’s new The National Institute for Health and Care Excellence (NICE) recommends that people with diabetes receive annual health checks to monitor and manage their condition and reduce the risk of complications. However, NHS figures suggest that less than 10 per cent of people are being offered the full series of tests recommended by NICE in some areas of England. NICE is now recommending that the latest Quality and Outcomes Framework (QOF), an incentive scheme for GPs, includes eight care processes to check the health of people with type 2 diabetes. The decision on whether to include the health checks in QOF will be made jointly by the BMA and NHS Employers later in the year.
What is to be included The care processes NICE wants to see included in QOF are measurements of body mass index, blood pressure, long-term blood glucose levels (HbA1c), cholesterol, a foot
Expert comment Libby Dowling is clinical adviser at Diabetes UK
NURSING STANDARD
check, a blood test to check the kidneys, and a record of whether the patient smokes. NICE also recommends retinal screening, which is delivered through a national programme.
Higher risk groups People with poorly managed blood glucose levels are at higher risk of developing complications. This can include hard-to-reach groups such as patients who do not speak English, people in prison, and those who are homeless. People who smoke are also at higher risk of developing cardiovascular disease.
How you can help your patient Check that patients with diabetes have access to Diabetes UK’s list of 15 Healthcare Essentials (see panel, right).This includes the NICE care processes and several other services, including retinal screening and emotional and psychological support. It also calls for access to structured education to help patients avoid complications.
‘The complications of diabetes are serious and can have a devastating effect on the person and their family. It is essential that healthcare professionals are given the time, training and resources to deliver the care processes properly. A proper foot check must be carried out, as people with diabetes are 30 times more likely to have an amputation.
Diabetes UK resources for healthcare staff on foot care www.diabetes. org.uk/Professionals/ Resources/Feet RCN Publishing articles An overview of foot ulceration in older people with diabetes Moakes H. Nursing Older People (September 2012). tinyurl.com/rcnfootolderpeople Reducing the risk of complications associated with diabetes Hill J. Nursing Standard (February 2009). tinyurl.com/ rcnreducingcomplications
‘We do hear from people with diabetes that a doctor or nurse will ask them how their feet are and call this a foot check. But the patient should be asked to remove their shoes and socks, and have the colour, shape and sensation of their feet checked. It is vital we get these processes right to protect the health of people with diabetes.’ september 17 :: vol 29 no 3 :: 2014 21
Nursing Standard 2014.29:21-21. Downloaded from journals.rcni.com by Univ of Pennsylvania on 12/01/15. For personal use only.
Diabetes Find out more
SPL
Essential facts Type 1 and type 2 diabetes affect 3.2 million people in the UK. Diabetes is associated with serious complications, including heart disease and stroke, which can lead to disability and premature death. It is the leading cause of preventable sight loss in people of working age in the UK. A quarter of people with diabetes will have kidney disease at some point in their lives, and the condition increases the risk of amputation. Good diabetes management has been shown to reduce the incidence of these serious complications.
NICE diabetes care pathway pathways.nice.org.uk/ pathways/diabetes Diabetes UK 15 Healthcare Essentials www.diabetes.org. uk/Guide-to-diabetes/ Monitoring/15-healthcareessentials
What’s new The National Institute for Health and Care Excellence (NICE) recommends that people with diabetes receive annual health checks to monitor and manage their condition and reduce the risk of complications. However, NHS figures suggest that less than 10 per cent of people are being offered the full series of tests recommended by NICE in some areas of England. NICE is now recommending that the latest Quality and Outcomes Framework (QOF), an incentive scheme for GPs, includes eight care processes to check the health of people with type 2 diabetes. The decision on whether to include the health checks in QOF will be made jointly by the BMA and NHS Employers later in the year.
What is to be included The care processes NICE wants to see included in QOF are measurements of body mass index, blood pressure, long-term blood glucose levels (HbA1c), cholesterol, a foot
Expert comment Libby Dowling is clinical adviser at Diabetes UK
NURSING STANDARD
check, a blood test to check the kidneys, and a record of whether the patient smokes. NICE also recommends retinal screening, which is delivered through a national programme.
Higher risk groups People with poorly managed blood glucose levels are at higher risk of developing complications. This can include hard-to-reach groups such as patients who do not speak English, people in prison, and those who are homeless. People who smoke are also at higher risk of developing cardiovascular disease.
How you can help your patient Check that patients with diabetes have access to Diabetes UK’s list of 15 Healthcare Essentials (see panel, right).This includes the NICE care processes and several other services, including retinal screening and emotional and psychological support. It also calls for access to structured education to help patients avoid complications.
‘The complications of diabetes are serious and can have a devastating effect on the person and their family. It is essential that healthcare professionals are given the time, training and resources to deliver the care processes properly. A proper foot check must be carried out, as people with diabetes are 30 times more likely to have an amputation.
Diabetes UK resources for healthcare staff on foot care www.diabetes. org.uk/Professionals/ Resources/Feet RCN Publishing articles An overview of foot ulceration in older people with diabetes Moakes H. Nursing Older People (September 2012). tinyurl.com/rcnfootolderpeople Reducing the risk of complications associated with diabetes Hill J. Nursing Standard (February 2009). tinyurl.com/ rcnreducingcomplications
‘We do hear from people with diabetes that a doctor or nurse will ask them how their feet are and call this a foot check. But the patient should be asked to remove their shoes and socks, and have the colour, shape and sensation of their feet checked. It is vital we get these processes right to protect the health of people with diabetes.’ september 17 :: vol 29 no 3 :: 2014 21
Nursing Standard 2014.29:21-21. Downloaded from journals.rcni.com by Univ of Pennsylvania on 12/01/15. For personal use only.
