The diabetes and dementia (DIADEM)
project: Improving the assessment and
management of patients with diabetes and
H MOOREY, K Aitchison, A Ali, A Puttanna and P De
Diabetes and Endocrinology, Sandwell and West Birmingham NHS Trust,
Aims: The DIADEM project was devised to address the gap in
knowledge in managing patients with diabetes and dementia. The
aim was to assess all patients admitted with both conditions and
provide focussed review.
Methods: Patients admitted between 15th March and 15th
September 2017 with both comorbidities were reviewed by the
specialist team via online referral system and outreach service.
Each patient had review of HbA1c, hypoglycaemia risk, vascular
and foot risk, and individualised speciﬁc targets for HbA1c and
Results: Sixty-six patients were reviewed (26 women, 40 men,
mean age 80 years). Mean HbA1c 62mmol/mol with 16 (25.8%)
having HbA1c <48mmol/mol. Results were available in 41
(62.1%) patients and were requested in 22 (33.3%) patients.
Forty-four (66.7%) patients had some form of intervention. In all,
30 vs 15 (57.7% vs 23.1%) patients were on zero medications pre
vs post review, 31 vs 16 (47.7 vs 30.8%) on one medication, 14 vs
5 (21.5 vs 9.6%) on two medications and 5 vs 1 (7.7 vs 1.9%) on
more than two medications. Patients on insulin were reduced from
25 to 14 (38.5% to 26.9%), and overall hypoglycaemia causing
medications reduced 28 to 16 (43.1% to 30.8%). All but six
patients had foot assessments. Fourteen patients were readmitted
within the following four months, all for non-diabetes-related
Conclusion: This is the ﬁrst and only known project focussing on
patients with diabetes and dementia. We provide a validated
method of inpatient assessment with proven beneﬁt. The project is
ongoing, resulting in ﬁnancial beneﬁt, patient safety (via reducing
hypoglycaemia risk) and reduction in polypharmacy.
Diabetes UK Education and Self-management Award
Medway NHS foundation trust: Variable
rate intravenous insulin infusion mandatory
A EPPS and R Watt
Diabetes Centre, Medway NHS Foundation Trust, Gillingham, UK
Background and aim: Variable rate intravenous insulin infusion
(VRIII) is used in an inpatient setting to achieve glycaemic control.
The National Adult Diabetes Inpatient Audit 2016 highlights the
7.1% of insulin infusions were considered inappropriate.
6.1% exceeded acceptable duration.
14% the transfer to subcutaneous insulin was incorrectly
There are several complications associated with VRIII including:
Our aim was to reduce harm caused by VRIII in a hospital setting.
Method: We implemented a mandatory competency in VRIII for
all staff who wished to use the device. Implementation of training
included face to face sessions, attendance of ward meetings and
handovers and an e-learning module.
Results and conclusion: Introducing the mandatory competency
led to a 50% reduction in associated errors reported via the Datix
system for the same three-month period in 2016 (June–August).
Out of 30 Datix received in the total 15-month study period, 29
incidents involved staff who were not trained. Only one incident
involved a member of staff who had completed the training.
Further research using freedom of information data involving 84
NHS trusts found that only 16 trusts had mandatory VRIII training
provided by the diabetes team. Many of the trusts commented that
they would like it to become mandatory; however, they had not
succeeded in implementation. We are hoping our data can be used
as an evidence for other trusts to implement mandatory training
and subsequently reduce VRIII-related errors and associated harm
caused by these errors across the NHS.
Revolutionising access and outcomes in
Type 2 diabetes structured education
programmes through remote care
L Jones, L DIAMOND, M Jenkins, S Adu and R Vallis
Diabetes, Oviva, London, UK
Aims: Patient uptake of diabetes-structured education (DSE)
programmes has been historically low in the United Kingdom;
evidence indicates that this follows the rigidity of their delivery
models. We hypothesised that a ﬂexible, patient-centred DSE
programme using digital health tools would help increase pro-
gramme accessibility. This remote care DSE programme was,
therefore, evaluated to establish its efﬁcacy in improving access and
clinical outcomes for adults with Type 2 diabetes.
Method: Clinical outcomes of 42 adults (M = 21/F = 21, mean
age 59 years) with Type 2 diabetes were evaluated at six months
following completion of the intensive 12-week diet and lifestyle
DSE programme. Registered dietitians delivered the programme
remotely using telephone/video calls or text messaging coaching via
the programme application, with access to supporting online and
video resources. Average baseline parameters included HbA1c
66.6mmol/mol (n = 42), body weight 104.2kg (n = 42), body mass
(n = 42) and blood pressure (BP) 134/77mm Hg
(n = 26).
Results: To date, programme uptake has been 74% of all eligible
referrals (n = 142). Clinical outcomes at six months showed
30.4% (n = 30) of patients achieved an HbA1c <48mmol/mol,
and on average, patients achieved an HbA1c reduction of
11.7mmol/mol (n = 30), a 4.7% body weight reduction (n = 22)
and 16mm Hg and 5mm Hg reductions in systolic and diastolic BP
(n = 12).
Abstracts of the Diabetes UK Professional Conference, 14–16 March 2018 DIABETICMedicine
ª 2018 The Authors, presented at the Diabetes UK Professional Conference ª 2018 Diabetes UK. 35 (Suppl. 1), 5–35