A multi-faceted approach improves inpatient diabetes care at a tertiary hospital.

BACKGROUND/AIMS: The results of the National Diabetes Inpatient Audit in 2013 showed that the Royal London Hospital had performed worse than the national average in several domains. The aim of this study was to improve inpatient diabetes care at the Royal London Hospital. METHODS: A multi-faceted intervention was designed via a Commission for Quality and Innovation workstream which spanned from April 2014 to March 2016. The National Diabetes Inpatient Audit results of 2013, 2016 and 2019 were compared to look at the outcomes and analyse the changes brought about by the intervention. RESULTS: There were statistically significant improvements in medication errors, prescription errors, glucose management errors and insulin errors in 2016 and 2019 as compared to 2013. More inpatients with diabetes were visited by the diabetes team, received foot assessment and patient feedback improved in both 2016 and 2019 as compared to 2013. CONCLUSIONS: A multi-faceted approach led to significant improvements in patient outcomes and experience, resulting in Royal London Hospital performing well above the national average in the National Diabetes Inpatient Audit in 2016 and 2019. This simple consultant-led multidisciplinary approach could be replicated in other hospitals in UK facing similar challenges.

Uncommon forms of diabetes.

Diabetes mellitus is a common condition which all clinicians will encounter in their clinical practice. The most common form is type 2 diabetes followed by type 1 diabetes. However, there are many other atypical forms of diabetes which are important for a clinician to consider as it can impact on the diagnosis and their management.This article focuses on maturity onset diabetes of the young (MODY), latent autoimmune diabetes in adults (LADA), ketosis-prone diabetes and other secondary forms of diabetes such as pancreatic cancer and haemochromatosis. We briefly describe the key clinical features of these forms of diabetes and their investigations and treatment.

COVID-19 and diabetes: What have we learned so far?

COVID-19 and diabetes are both pandemics with major impacts on global public health. While the response to COVID-19 has been rapid and progressive to reduce risk of harm, the response to the diabetes pandemic has been somewhat more muted. People with diabetes have been disproportionately affected by COVID-19, with growing evidence of higher mortality and morbidity. In this article, we discuss the impact of COVID-19 on our diabetes service in an urban area in the UK. We discuss the impact on our patients and ourselves, and the possible lessons we can carry into the future.

Effectiveness and acceptability of metformin in preventing the onset of type 2 diabetes after gestational diabetes in postnatal women: a protocol for a randomised, placebo-controlled, double-blind feasibility trial­Optimising health outcomes with Metformin to prevent diAbetes After pregnancy (OMAhA).

INTRODUCTION: Up to half of all women diagnosed with gestational diabetes mellitus develop type 2 diabetes within 5 years after delivery. Metformin is effective in preventing type 2 diabetes in high-risk non-pregnant individuals, but its effect when commenced in the postnatal period is not known. We plan to assess the feasibility of evaluating metformin versus placebo in minimising the risk of dysglycaemia including type 2 diabetes after delivery in postnatal women with a history of gestational diabetes through a randomised trial. METHODS AND ANALYSIS: Optimising health outcomes with Metformin to prevent diAbetes After pregnancy (OMAhA) is a multicentre placebo-controlled double-blind randomised feasibility trial, where we will randomly allocate 160 postnatal women with gestational diabetes treated with medication to either metformin (intervention) or placebo (control) tablets to be taken until 1 year after delivery. The primary outcomes are rates of recruitment, randomisation, adherence and attrition. The secondary outcomes are maternal dysglycaemia, cost and quality of life outcomes in both arms, and acceptability of the study and intervention, which will be evaluated through a nested qualitative study. Feasibility outcomes will be summarised using descriptive statistics, point estimates and 95% CIs. ETHICS AND DISSEMINATION: The OMAhA study received ethics approval from the London-Brent Research Ethics Committee (18/LO/0505). Trial findings will be published in a peer-reviewed journal, disseminated at conferences, through our Patient and Public Involvement advisory group (Katie's Team) and through social media platforms. TRIAL REGISTRATION NUMBER: ISRCTN20930880.