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Significant reduction in diabetes health risks through self-management

posted 18 Dec 2017, 00:15 by Hollie O'Connell   [ updated 15 Jan 2018, 01:49 ]

South Tyneside 
NHS Foundation Trust 
 
Alison Stewart 
 Safe Care Lead Diabetes 


15 January 2018 

Patient self-management is significantly reducing short and long term health risks associated with diabetes 



By recruiting Flo as part of the team, patients in South Tyneside are becoming more capable and confident to self-manage meaning clinic appointments are able to be reduced, and glycaemic control is demonstrating significant improvement reducing both short and long term associated health risks.  Alison explains what Flo means for her patients and her service.


What do South Tyneside Diabetes Specialist Nurses do?  

Diabetes Specialist Nurses (DSN) are qualified nurses with special expertise in the care and treatment of people with diabetes.  In South Tyneside we have 4.4 whole time equivalent DSNs delivering a broad range of services from specialist nurse-led inpatient and outpatient care to pre-pregnancy clinics and patient education.
 

CASE STUDY  
A patient with type 2 diabetes was referred to the Diabetes Specialist Nurse Service demonstrating poor glycaemic control resulting in a change to her oral medication and basal insulin to twice daily mixed insulin.  However, the patient’s high glucose levels carried short term risks for her of increased tiredness and lethargy and thirst plus polyuria and a more likely risk of infection.  Equally as significant for the patient are her long term complications due to her diabetes remaining uncontrolled such as heart attack and stroke, retinopathy, maculopathy, kidney disease, damage to her nerves and circulation in her feet, and also her autonomic nervous system.

The lady’s HbA1c at the outset was 94 mmol/mol, recognising the importance of supporting her to self-manage her diabetes better, we introduced her to Florence.  The patient agreed and began receiving messages from Flo targeting at motivating her towards lifestyle changes that she could make to support a reduction in her HbA1c.  The patient also replied to Flo 4 times a day with her blood glucose reading, enabling her to act on Flo’s advice, encouraging her to improve her capability and confidence to self-manage.  These are the kinds of interactions that she had with Florence;

  • “As your sugar levels improve your symptoms should reduce, Flo” 
  • “Hi it’s Flo, have you looked at your sugar levels and made any changes?” 
  • “Have you managed to increase your activity levels, take care, Flo” 
  • “Hi Flo here, please do not forget to change your needles, take care”
Initially I decided to set time aside to review her readings and to make contact twice weekly via Flo for targeted intervention; for example to advise her to increase her insulin.  However once there was a noticeable improvement in her glycaemic control, I was able to reduce my contact to once a week and reduce Flo’s interactions around testing to once daily.
 

What did the patient think?  

The patient was previously seen in Sunderland, but in the 7 month period since she started using Flo, she only needed 4 clinic appointments.  The patient feedback was that being able to be supported by Flo was a major benefit for her, not only as she had regained control of her condition, but that she had previously had to rely on her husband to bring her to her clinic appointments and as he worked shifts, it wasn’t always convenient.  The patient also commented that she found texting Flo to be helpful in improving her self-management of her diabetes.
 

What are the benefits? 

There are a number of benefits of using Flo from my perspective as a Diabetic Specialist Nurse.  Firstly, using Flo has certainly freed up clinic appointments, and as the number of referrals we receive increases, this is an important consideration.  Importantly though, using Flo also meant the patient was now being regularly reviewed in order to support her aim of improving glycaemic control.  This lady’s HbA1c dramatically improved as indicated by an HbA1c of 52mmol/mol, and she has now significantly lowered her risk of long term diabetes related complications.  I would recommend Flo to other clinicians and feel that many would find using Flo helpful.