Lambeth Diabetes Learning Event Local update Dr Neel Basudev GP Lambeth Clinical Director Diabetes Health Innovation Network Clinical Lead Out of Hospital Care London Diabetes Network

Things to cover Diabetes state of play Self-management Learning today Type 2 diabetes prevention- Healthier You Diabetes Book and Learn Tier 3 weight management Foot care pathway Self-management Technology Learning today Programme

Type 2 Diabetes Prevention Diabetes state of play Type 2 Diabetes Prevention

Prioritisation Approach HbA1c 44-47mmol/mol or Fasting Plasma Glucose (FPG) 6.5–6.9mmol/l Healthier You, NHS diabetes prevention programme (NDPP), commissioned by NHS England first line option STEPs to prevent diabetes commissioned locally in Lambeth second line option 6 months into new contract 82% have reduced weight 97% reduced Hba1c Average Hba1c change -4.66 mmol/mol

Diabetes state of play Book and Learn

CDEP structured education module available

Personalised journey from referral to completion of a course Motivational techniques to encourage attendance from a specialist call center run by Spirit Healthcare Allows for referral from multiple sources, including self-referral Provides continued support – self- management resources, social prescribing, patient able to see own data (HbA1c etc.) and access refresher learning Choice of all currently commissioned courses across 12 CCGs & 18 providers including remote/digital courses Improves coding in primary care – updating SNOMED codes automatically www.diabetesbooking.co.uk

Tier 3 weight management Diabetes state of play Tier 3 weight management

Overview of 2 year pilot Delivered by Dietetics Dept. at Guy’s & St Thomas’ but the programme itself will be delivered in the community The programme is for: Over 18’s BMI ≥40 or BMI ≥35 with Type 2 Diabetes Motivated to lose weight Willing to take part in a group based programme requiring regular attendance The referral form can be found on DXS or EMIS and referrals must be sent via eRS A choice of two programmes: BALANCE - Nutritional education alongside behaviour change, psychology and physical activity. 12 group sessions over the course of a 12 month period FAST - Evidence-based total meal replacement programme for more substantive, rapid weight loss followed by food re-introduction, nutritional education, psychology and physical activity. 15 group sessions over the course of a 12 month period

Diabetes state of play New Foot Pathway

Foot facts Today, and every day, how many people with diabetes in England will have a toe, foot or leg amputated? 23 The NHS in England spends how much per year on diabetic foot problems over £1 billion What % of patients survive for 2 years after major amputation in diabetes Around 50% What is % 5-year survival after diabetic foot ulcer? 58%, similar to that for colorectal cancer, and lower than for breast or prostate cancer

Multi-Disciplinary Footcare Teams (MDfT) - Lambeth Clinics available at: St Thomas’ Hospital – Monday to Friday 09:00-17:00 King’s College Hospital – Monday to Friday 09:00-17:00 Guy’s Hospital – Thursdays 09:00-13:00 SOS at King’s before 12:00 Monday to Friday Don’t wait, refer within 24 hrs via eRS What to refer: Any foot ulceration Acute Charcot foot (hot/swollen/painful foot) Any foot Infection Septic patients should be referred to A&E with in-patient MDfT support Concerns or unsure? Refer anyway

Self-management Technology

South London Diabetes test bed Support practices to introduce care and support planning for diabetes Employ technology that allows people to take their care plan with them, wherever they go. Link people to the resources that can help them manage their diabetes. Utilise technology to communicate more meaningfully with our patients about their diabetes. Start well, live well, age well

Personalised support Recall Care planning Habituation Maintenance 1 2 Month 1 2 3 6 12 Booking process Information gathering appointment Care planning appointment Support to access resources Annual review Video via text message or e-mail explains why care planning is important and what to expect Hyperlink included to make an appointment Care planning preparation Introduction to Healum platform Video message with their results Better understanding Detailed care plan and results available in Healum Video message with their care plan Linked to education and social prescribing resources Useful resources and information constantly updated in Healum Nudging from app to keep focus on goals Video message to keep up motivation at 6 months Video message to prepare for annual care plan review Link to Healum self assessment Click to make appointment The new journey for patient FE showing key milestones and what the patient will be experiencing along the way via partnership contributions to make the entire process and year of care as personalised as it can be.

Communication is key

Learning today Programme

This afternoon Flash Glucose Monitoring Anna Hodgkinson, Consultant Pharmacist Weight loss interventions for T2DM Alastair Duncan, Principal Dietician GSTT Management of T2DM in practice Piya Sengupta, Consultant Diabetologist GSTT

Thanks for listening