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Diabetes admissions cut

Intermediate care programmes to manage patients with diabetes have led to improved outcomes and reduced hospital admissions, according to the preliminary results of an initiative in the East of England.

The intervention, which included the creation of a multidisciplinary team of GPs working with hospital and community-based specialists who delivered patient reviews in GP practices, reduced average HbA1c levels by more than 1% and reduced the mean number of hospital episodes by 30% per month.

The positive results come weeks after a major Department of Health-funded evaluation by the Nuffield Trust, a health policy think thank, found new care pathways – including integrated care teams – raised rates of admissions and even deaths.

Community-based specialist podiatrists provided diabetic foot clinics while specialist nurses and dieticians ran clinics in GP practices to offer weight management support to patients as well as education and advice to GPs who participated in the programme, which began in two practices in east Cambridgeshire but was extended to 17 practices in the area by the end of the six-month evaluation period.

After six months, the proportion of patients with HbA1c levels above 9% fell from 39% to 13% in the first two practices.

Among all 521 patients managed in the integrated care programme over the first six months, mean HbA1c levels dropped from 9.7% to 8.4%, while weight dropped from 95.6 to 90.6kg overall. Both were clinically significant.

The overall mean number of hospital episodes per month dropped from 38 to 27, which was also statistically significant.

Dr David Simmons, lead diabetes consultant at the institute of metabolic science at Cambridge university hospitals NHS foundation trust concluded: ‘the integrated approach to diabetes care appeared to have a substantial impact on metabolic outcomes and hospitalisation in a relatively short period of time.'

The research was presented at the Diabetes UK annual professional conference in London last week.

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