Lambeth Diabetes Learning Event Local and regional 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 Horizon scanning Learning today Type 2 diabetes prevention Diabetes Book and Learn Tier 3 weight management General roundup Horizon scanning Technology Learning today Programme

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

Overview of ICS programme

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 NDPP 42-43mM/M: 50 34 8 44-47mM/M: 131 87 38 STEPS 42- 43mM/M: 38 36 44-47mM/M: 19 30

South London cumulative referrals Prioritisation approach

Eligible referrals received by CCG (June 2016-May 2018)

South London cumulative Initial Assessments (IA) 7,548 Initial Assessments attended 63% conversion rate from referral

No. of participants attending 1st session by CCG 3,219 1st sessions attended 43% conversion rate from IA to 1st session June 16 – may 18

No. of participants who have completed the programme by CCG 732 Finishers Have to take into account time lag 9 month programme and we received the majority of our referrals in the second year of the contract Majority of people who have started on programmes will not yet have had a chance to complete ****** have to take into account time lag, it is a 9 month programme and we received the majority of our referrals in the second year of the contract therefore the majority of people who have started on programmes will not yet have had a change to get to end.

Status of referrals Lots of participants currently active in the programme *e.g. Merton – only [properly started after Christmas so not had many people who would have been able to finish yet June 16 – april 18

Drop outs and when they left the programme Drop-out rates once started on the programme are very low

Mean weight change at 6 months of -2.6kg Mean weight change at 6 months for participants who had a valid weight at IA and 6 months by CCG Mean weight change at 6 months of -2.6kg June 16 – april 18

Summary of achievements 11,982 eligible referrals received 7,548 Initial assessments attended 63% conversion rate from referral to IA 3,219 1st sessions attended 43% conversion rate from IA to 1st session 732 finishers (as of April 2017 data) Mean weight change at 6 months of -2.6kg (as of April 2017 data) ****** have to take into account time lag, it is a 9 month programme and we received the majority of our referrals in the second year of the contract therefore the majority of people who have started on programmes will not yet have had a change to get to end.

Diabetes state of play Book and Learn

CDEP structured education module available

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

Overview of 2 year pilot Pilot Tier 3 adult weight management service for patients with a GP in Southwark, Lambeth, Bromley, Bexley and Lewisham. Run until 31st March 2020 and it is a 12 month multi-disciplinary programme of group based sessions 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

What does the programme consists of? A 1-1 initial assessment with a dietitian 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 Follow up at 18 and 24 months Review by a clinically-led MDT within the medical obesity service Integrated support from clinical psychologist with option for 1:1 support if required Group programmes in each borough. Evening and weekday groups available. Participants can choose from any of the available locations in any borough.

Diabetes state of play General roundup

A few other reminders 75%, of patients with non-diabetic hyperglycaemia (NDH) should be on the High Risk of Diabetes register using read code 14O80 8 care process and three treatment targets Flash glucose monitoring

Horizon scanning Technology

How to improve self-management Currently self management tends to just activate education but with the new pathway, all key areas will be activated by the test bed partners to enable more effective self management to take place.

Personalised support What Patient FE would be offered by our new model of care Recall Care planning Habituation Maintenance 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.

Learning today Programme

This afternoon Diabetes Book and Learn Alison Meadows, Priority Digital Health Pregnancy in annual review for women with T2DM Dr Kate Hunt, Consultant in Diabetes and General Medicine, King’s College Hospital NHS Foundation Trust Monogenic and Mitochondrial Diabetes- ensuring the correct diagnosis Anna Reid, Diabetes Nurse Consultant, Guy’s and St Thomas’s NHS Foundation Trust

Thanks for listening