ABSTRACT
Aims: At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed the risk of 12-month mortality following an episode of severe inpatient hypoglycaemia. Method(s): Reportable NaDIA harms of patients admitted during the period 2018-2022 were recorded into a dataset. Applicable patient records were reviewed at 12 months following the event to see how many patients were deceased and details of comorbidities at the time of the severe hypoglycaemic episode were collected. Result(s): To date, of 107 inpatients who experienced a severe hypoglycaemic episode 55% were deceased within 12 months. In patients admitted during the peak of the Covid-19 pandemic recorded as year April 2020/March 2021, 80% of patients who had a NaDIA hypoglycaemic event died within 12 months. Conclusion(s): Mortality rate following an episode of inpatient hypoglycaemia appears to be several-fold higher than previous reported rates of 4.45%-22.1% for community-dwelling individuals who experience a severe hypoglycaemic event. This maybe partially explained by the increased frailty, polypharmacy and multimorbidity among this cohort, but there is evidence linking hypoglycaemia with cardiovascular mortality. Although no causality between severe inpatient hypoglycaemia and death can be inferred from this study because of the observational nature, it does highlight the importance preventing inpatient episodes of hypoglycaemia through effective monitoring and proactive treatment modification.
ABSTRACT
Aims: Covid-19 precipitated an abrupt shift to non-face- to- face (digital) consultation. Some believe that this was overdue and that digital is better for many patients. Our aim was to establish the extent to which people with diabetes were equipped to manage digital consultation and what they felt about it. Methods: We surveyed 1,000 people with diabetes (500 type 1, 500 type 2) from our local, largely deprived community with a user-approved questionnaire, tested for face validity and readability. Results: Response rate was 376/1000 (38%);132 (35%) type 1 diabetes, 218 (58%) type 2 diabetes, 1% other and 6% blank. Age of respondents was: ≤30, 0%;31-40, 4%;41-50, 7%;51-60, 12%;61-70, 17%;71-80, 52%;81-90, 3%;and blank, 5%. Treatment was: diet alone, 11%;diet and tablets, 39%;diet and insulin injections, 24%;diet, tablets and glucagon-like peptide-1 receptor agonist, 2%;insulin pump, 9%;and blank, 6%. Some 22% were attending the hospital clinic;74% not and 4% blank. Only 40% patients had access to a video calling device and only 35% had ever used it. Separate Likert scales showed: 79% strongly preferred or preferred face-to- face consultation, 17% strongly preferred or preferred telephone;and only 6% strongly preferred or preferred video consultation;66% recognised limitations in examination, weight and blood pressure checks with digital. Summary: Our survey, representative of type 1 and type 2 diabetes and of all treatment modalities but with underrepresentation of very young respondents, reveals that most patients did not have equipment for digital consultation and 79% preferred face-to- face consultation.
ABSTRACT
Aims: England and Wales report on average, 700,000 annual pregnancies. From these 5% are complicated with hyperglycaemia with 87.5% of these Gestational diabetes (GDM). Pregnant women living with obesity are at higher risk of developing GDM. There is a linear relationship between glucose and adverse pregnancy outcomes. We noted a marked increase in the number of referrals with GDM to our service in 2021. The aim of this study was to compare the incidence of GDM and the characteristics of women under our service in 2021 to the pre-pandemic data from 2019. Methods: Data were collected retrospectively, analysing the data of women with GDM during the time period of 1st May to 31st July 2019 and compared to the same period from 2021. Results: The number of positive OGTT results increased by 209% in 2021 (n = 107 vs 51). In 2021 there was a 66% increase in the number women with GDM with a Body Mass Index (BMI)≥30kgm2 (36 to 60). The average BMI of this group increased from 34.9kg/m2 in 2019 to 36.5 in 2021 although this failed to reach statistical significance. Conclusion: The local incidence of GDM is higher in 2021 compared to 2019. This is driven by an increase in the number of women diagnosed with GDM with a BMI≥30. We hypothesize that this may be a result of sedentary lifestyle brought on by the lock downs because of the pandemic. Further work may be warranted in this area using a larger sample size derived nationally.
ABSTRACT
Aims: The covid-19 pandemic was associated with legally restricted public movement (lockdowns) and reduced access to face-to- face consultation for diabetes in primary and specialist care. The aim of this study was to assess the impact of the pandemic on requests for specialist telephone support. Methods: Retrospective analysis of calls for telephone support before and during the covid-19 pandemic via three separate extensions tailored to specific needs: (1) diabetes emergency advice line (direct diabetes specialist emergency advice 08.00-20.00, Monday to Friday and 08.00-16.00 Saturday and Sunday);(2) diabetes general advice line (a 24/7 telephone answer machine, typically used by patients and carers, answered repeatedly Monday to Friday 08.00-18.00);and (3) a diabetes community line, typically used by healthcare professionals in the community. We arbitrarily defined 'pre-covid' as calls up to 31/3/20 and 'during covid' as calls thereafter to 1/5/21. Results: Mean ( ± SD) calls per calendar month (pcm) increased highly significantly: 81 ( ± 80) pcm pre-covid to 248 ( ± 72) pcm during covid, p < 0.001. Emergency advice line calls did not increase: 15 ( ± 5) pcm pre-covid to 18 ( ± 11) during covid, p = 0.9, general advice line calls increased non-significantly: 161 ( ± 19) to 194 ( ± 68), p = 0.1, but community calls increased highly significantly: 16 ( ± 6) to 36 ( ± 12), p < 0.001. Although calls rose during lockdowns, the monthly picture was more of a sustained increase after the first lockdown. Summary: The covid-19 pandemic has been associated with a sustained increase in requests for non-emergency diabetes specialist team advice, particularly from primary care professionals in the community.