1. 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

2. 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

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

4. Overview of ICS programme

5. 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:
44-47mM/M:
STEPS
42- 43mM/M:
44-47mM/M:

6. South London cumulative referrals
Prioritisation approach

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

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

9. 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

10. 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.

11. 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

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

13. 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

14. 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.

15. Diabetes state of play
Book and Learn

16. CDEP structured education module available

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

19. 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

20. 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.

21. Diabetes state of play
General roundup

22. 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

23. Horizon scanning
Technology

24. 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.

25. 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 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.

26. Learning today
Programme

27. 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

28. Thanks for listening