DIABETES ACTION PLAN 2010

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DIABETES ACTION PLAN 2010 QUALITY CARE FOR DIABETES IN SCOTLAND Current initiatives that will help address this target include the growing availability of structured education programmes for people with established diabetes to help them manage the condition more effectively and ongoing discussions with NHS 24 on developing its services for people with diabetes. The Scottish Ambulance Service is considering a revision of its guidelines to reduce episodes of repeat severe hypoglycaemia. Hypoglycaemia Hypoglycaemia (hypo) occurs when blood glucose levels drop below normal levels and is a common complication of injecting insulin. It can also occur in people with type 2 diabetes who are taking insulin or certain oral medication. It can be classified as mild, moderate or severe; severe hypoglycaemia needs third party help with recovery. The Scottish Ambulance Service (SAS) has adopted ‘See and Treat’ Guidelines which recommend that in most cases it is preferable for people with hypoglycaemia to remain at home. Evidence from a research project under way in Stirling University suggests that around 7,000 diabetes calls to the SAS relate to hypos including a significant number of repeat callers. It is thought that as the number of people with type 2 diabetes taking insulin increases, there may well be a corresponding increase in severe hypoglycaemia. 45
DIABETES ACTION PLAN 2010 QUALITY CARE FOR DIABETES IN SCOTLAND 3.12.3 Diabetic ketoacidosis (DKA) Data on the incidence of DKA over the past five years shows an upward trend, though this may be due to more accurate reporting and coding. The Type 1 Diabetes Short Life Working Group recommended that an audit take place in 2010-11, and this is expected to eliminate uncertainties around current data. The Type 1 Diabetes Short Life Working Group report recommended the introduction of a DKA awareness campaign, modeled on the Vanelli campaign 5 that is understood, at one point, to have virtually eliminated DKA in newly diagnosed patients in Parma. Care bundles for DKA have also been developed for use by Accident and Emergency and medical ward-based staff. These are currently being piloted before being considered for further roll out. Primary Care is expected to have a central role in reducing diabetic hospital admissions through early recognition and management of diabetic presentations, complications, and potential emergencies such as diabetic ketoacidosis (DKA) and hypoglycaemia. Actions we will take: 1. We will reduce the incidence of hypoglycaemia that result in emergency admissions by: • supporting the development of interventions to improve post-hypoglycaemia patient support through enhanced communication (responsibility SAS and Scottish Diabetes Group). • NHS Boards, through their diabetes Managed Clinical Networks, will review the care pathway of people who experience severe hypoglycaemia. 2. Incidence and care of diabetic ketoacidosis (DKA) will be improved by: • The SDG and SGHD will explore the roll out of a DKA awareness campaign for children with undiagnosed diabetes. • NHS Boards, through their diabetes MCN, will review care pathways for the presentation and management of DKA throughout the whole episode. • NHS QIS will commission a national audit of DKA. • The Diabetes Education Advisory Group will oversee the roll out of care bundles for DKA. Healthcare Quality Indicators: safe; timely. 46 5 As set out in the Type 1 Diabetes Short Life Working Group Report (2010)
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DIABETES ACTION PLAN 2010

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