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Covid-19 Primary Care Resources


Diabetes reviews


diabetes


How to approach diabetes reviews and tools to support remote collection of data

This information is sourced from NHSEDiabetes UK, and the Primary Care Diabetes Society (PCDS):

Studies on Covid-19 related mortality in Type 1 and Type 2 diabetes reveal that people with type 1 diabetes were 3.5 times more likely to die in hospital with Covid-19 than those without diabetes, and people with type 2 diabetes were just over twice as likely to die

The PCDS recommend that people with diabetes should intensify their glycaemic control as required for the primary prevention of Covid-19 illness

Whether to review remotely or face to face

  • NHSE now advise that remote triage should be used wherever possible with patient preference taken into account. Where face to face care is given GPs should co-ordinate care so that as much as possible is done in a single consultation
  • If data can be gathered by the person at home, these can be included in a pre-review questionnaire, which can then be reviewed to decide if a remote consultation is appropriate

Who to prioritise for review

The PCDS advise that practices maintain diabetes reviews but that recalls should be prioritised on the basis of clinical need. The following practice-generated searches are suggested:

  • Due/overdue reviews/ previous nonattenders
  • Poor control (HbA1c ≥75 mmol/mol; BP or lipid targets not met; high CVD risk)
  • On insulin or sulphonylurea (hypo risk assessment)
  • Comorbidities/vulnerable
  • Recent diagnosis – tight control urgent to ensure legacy effect

Tools to help people with diabetes gather data and perform self examinations at home

Remote foot assessment

  • Ask the person to document symptoms related to the feet and legs, visually check all parts of their feet themselves (using a mirror or with help), including identifying dry or cracked skin, changes in colour, ulcers, rashes or blisters
  • If changes or concerns are identified, try to arrange photos to be shared prior to the consultation
  • The Diabetes UK ‘Touch the Toes’ test uses the validated Ipswich Touch Test to enable patients to check sensation in their feet

SGLT2 Inhibitors

  • SGLT2i tablets can mask the symptoms of diabetic ketoacidosis, which can be caused by coronavirus
  • Patients with type 1 diabetes were advised to stop taking SGLT2i during March and April 2020. Updated guidance now advises that their doctor ‘may’ want to stop their SGLT2i. They need to be aware of the significantly increased risk of DKA and reminded about presenting symptoms, ketone measurement, sick day guidance and prompt medical advice
  • Patients with Type 2 diabetes should continue to take SGLT2i tablets unless they become unwell in which case they should stop them

Diabetes education

Diabetes education for patients whilst unable to access face to face education is available from Diabetes UK learning zone

Diabetes UK has online advice and a helpline for patients with diabetes on managing their condition and health checks

Written by Dr Poppy Freeman

See also: Long term condition reviews