1. 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

2. 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

3. Type 2 Diabetes Prevention
Diabetes state of play
Type 2 Diabetes Prevention

6. 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 mmol/mol

8. Diabetes state of play
Book and Learn

9. CDEP structured education module available

10. 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

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

12. 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

13. Diabetes state of play
New Foot Pathway

14. 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

16. 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

17. Self-management
Technology

18. 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

19. 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 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.

20. Communication is key

21. Learning today
Programme

22. 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

23. Thanks for listening