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HbA1c down 29 mmol in 6 week programme

posted 7 Dec 2015, 10:49 by Philip O'Connell   [ updated 11 Mar 2016, 09:29 ]








Iain Trayner 
NHS Western Isles 


Updated January 2016 

Erin meets ‘Flo’ 


Erin is 16 years old, she was diagnosed with Type 1 diabetes when she was 12 years old. Just like any other teenager Erin has a busy life between school, socialising and like most people Erin’s age, her phone is glued to her fingers. Unfortunately Erin’s blood glucose control has been erratic over the last few years with several admissions as a result of her diabetes since her diagnosis. Although Erin would see the Diebetologist several times a year, she would forget to attend her follow up clinic appointments with the nurse and with the pressures of teenage life she didn’t see her diabetes as a big problem. 

In September this year (2015) Erin was admitted to hospital with an HbA1c of 112 mmol, this meant that Erin was at a very high risk of developing other complications such as kidney disease, eye disease and cardiovascular problems. Her long term future did not look good.

During her admission the diabetes team were working on a project to introduce a system called ‘Florence’. Flo, as we call her now helps people to manage their diabetes by asking for regular updates via SMS text about their Blood glucose levels and Flo also provides advice on what to do depending on the results. The team thought that Erin would benefit from Flo because it allows direct communication at Erin’s level – via her mobile phone, no letters being sent and forgotten about only to result in another missed appointment.

The specialist nursing team discussed her situation and made sure that she was aware of the risks that she faced by not controlling her diabetes. Erin agreed to join Flo and was the very first person to benefit from this type of system in the Western Isles. She understood that Flo was not an emergency service and that if she felt unwell she was to contact her local diabetes specialist nursing team or NHS 24.

The team put together a clinically approved protocol that would prompt Erin for blood glucose readings twice a day and then give clear instructions on what to do if her blood glucose levels were high or low. Erin had already been given this information in a booklet but that was in the bottom of the wardrobe somewhere!

Once Erin was discharged from hospital she got on well with Flo, checking her blood glucose and reacting as per the advice given in the text messages. Erin has since attended all of her follow up appointments with the diabetes specialist nursing team and continues to send in her readings every day. The diabetes specialist nurse can check how Erin is doing remotely and then get in touch if need be, Erin can also contact the team through Flo. After 6 weeks the diabetes nurse tested Erin’s HbA1c again and it had come down to 83 mmol. A reduction by 10 mmol means that the person’s risk of developing serious complications as a result of their diabetes reduces by 20%, which means that Erin has reduced her risk by 60% in 6 weeks! Erin was really encouraged by this and is now determined to reduce this even further. If Erin keeps the same average blood glucose levels for another 6 weeks then she will reduce this down to around 72 mmol – another 20% off the risk without doing anything differently!

Erin has done a fantastic job. She still has her up’s and down’s with occasional spikes in blood glucose but she still has to live her life normally and it’s the average level over a period of months that matters. The lower this is, the better the outcome will be.


Update January 2016

We are so pleased to be able to report that Erin's HbA1c is now down to 73 mmol.  A remarkable achievement in just three months with Flo and the health benefits of an 80% reduction of the risk of serious complications for Erin are substantial and tangible.


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