Diabetes 13th July 2022

NHS Sheffield PLI event

TURNAROUND TIME – DIABETES FOCUS, POST PANDEMIC

Wednesday 13 July 2022,2-5pm, SWFC (registration from 1.20 onwards)

Your patients with diabetes have suffered over the two years of the Pandemic. The number accessing diabetes reviews and monitoring has not picked up after the lockdowns, and their diabetic control has in many cases deteriorated over this time.

This PLI is an update in general management mainly of Type 2 diabetes and covers the emerging problem of young people diagnosed with this disease.

There are an estimated 31,000 people in the city living with diabetes. This PLI will consider how best to encourage access to reviews, as well as maximise opportunities to improve lifestyle management of this common disease.

This event will cover diabetes topics suitable for GPs, Practice Nurses and Health Care Assistants. The event will include presentations from local GPs, hospital specialists and pharmacists who will provide you with an update on:

• Issues from the National Diabetes Audit, including the impact of the pandemic on treatment targets, and local information regarding diabetes complications

• Preventative services, lifestyle interventions, and new initiatives around diabetes reversal

• Emerging good practice in primary care

• Treatment options including pharmacological options and when to make a specialist referral

• Diabetes in pregnancy and pre-conceptual care

• Caring for young people with Type 2

• Foot care

Agenda:

TURNAROUND TIME – DIABETES FOCUS POST PANDEMIC 

Stalls – REED Wellbeing/STH Dietetics

2pm Welcome and context Presenter Dr A McGinty

10 minutes: Introduction – the pressing issues. Presenter Dr J Stephenson

• Post pandemic NDA; Reviews; headline data, obesity rates, the urgency of it all; sharing good practice

• What to expect in this PLI. Sharing in Practices                                                           

• Tools like UCL/PARM; One Stop Shop overview 

15 minutes: 1- The Low Calorie Diet Pilot Service – Why & How. Presenter Dr D Evans

• The research basis for the weight loss / LCD programme (DiRECT study)

• How the service programme runs in Sheffield

• Whom and how to Refer

15 minutes: 2- Diabetes Care in Sheffield - Challenges, Opportunities and Priorities. Presenter Dr R Gandhi 

• Pandemic problems seen in STH: diagnosis of T1DM in DKA, severe hypos.

• How primary care can use this info to inform practice 

• Appropriate referrals to the Specialist service, including 

• Pre-Op referrals to improve surgery outcomes

15 minutes:  3-Sheffield Guideline (NICE NG 28). Presenters  C McMuarry and Dr S Song

Current guidance about treatment options related to clinical situations including the upcoming new guide about renal calculator for risk of renal failure KFRE (kidney failure risk equations)

Brief update of new medications and new indications e.g. empagliflozin- and dapagliflozin 

Refreshment and comfort break and networking/looking at stalls/moving into the group rooms 

Start 3:45pm

1 – ‘DOING DATA’ Presenters Dr L Cormack and Dr J Stephenson 

Dr Lucy Cormack leading. JAS Presentation of NDA data per PCN & Practice. 7Hills experience with One Stop Shop. 

South Asian Project - Presenter Dr J Stephenson and AGilani – Brief intro by JAS & presentation by Alia Gilani Specialist Pharmacist – reaching this community; Q&A

2 – ‘IMPROVING PREGNANCY’- Presenters Dr P Madhurvata, Dr E Walkinshaw and K Clark DSN 

• Update on STH recent audit regarding preparation for pregnancy – urgent messages for primary care (glycaemic control, possibly teratogenic drugs, folic acid etc)

• the pre-pregnancy clinic (though 50% of pregnancies are unplanned) and referral

• Gestational Diabetes

3 – ‘YOUNG TYPE 2’ Presenter Dr S Song

• Defining the problem in Sheffield – how many patients and their characteristics (race, weight, deprivation)

• The clinical trajectory of a young person developing T2 before 40 (as regards CVD risk, diabetic complications, lipids, and hence the urgency of management of risk)

• How to address this in their clinical care (basic advice for how a Practice can do this; their special needs; clinic or writing for advice from Specialist clinic)

4 – ‘TECHNOLOGY and ME’     Presenter Debbie Barr, DSN and a colleague:-

• My Pathway, ACCURX, Flash/CGM/, smart / green pens

• Resources for all people with diabetes

5 – ‘VISION FOR THE FUTURE’ – The Diabetic Eye Screening Service Presenter H Nosek

• Problems over the pandemic; how things are improving

• Possible new DES screening intervals

• Primary Care returning PNLs & coding issues

6 – ‘HCA EXPERTISE’ – Biometrics update’ Group run by PCDN team for HCA’s – Presenter S Bentley and H Hibberson

general overview / doing the diabetic review / foot check = LASTS FULL HOUR

5pm Close – no plenary

Material/slides to be available after meeting and links to guidelines etc

Comments from Dr Song

Differentiating between type 1 and type 2 diabetes in a young person is challenging because type 1 diabetes are becoming more obese and type 2 diabetes is increasingly diagnosed young. The first question to ask is whether this is autoimmune or non-autoimmune diabetes. So please check the type 1 diabetes antibodies. If uncertain, please contact the diabetes team who can advise.

There is no data on statin in young type 2 diabetes but we know that statin does reduce CVD risk in younger patients age below vs above 65. One can extrapolate that this will also benefit the young T2D given the high lifetime risk for CVD. There is Sheffield lipid guideline for young T2D published in 2020, so please refer to that guideline. Remember to use lifetime risk which basically counting up the number of risk factors, rather than using risk calculator.

Young women with type 2 diabetes is going to be on glycaemic, BP and lipid medications which may not be safe with pregnancy. So pre-pregnancy discussion must be routinely offered to all these women regardless of their intentions as 50% of pregnancies are unplanned.

LOCAL DIABETES UK GROUP – a very helpful resource for all people with diabetes, and offering special support to those newly diagnosed. With pt consent of course, use the very brief referral form on their website or offer this to the patient, or the Group’s telephone number if they prefer to refer themselves.

TEL NUMBER 07429 385554

Email: diabetesuk.sheffield@gmail.com

WEBSITE  www.sheffielddiabetesuk.group

Link to view recording: