Poster 23: Diabetes pathways for the management of patients at risk

Background: Insulin dose adjustment in diabetes is challenging and often patients continue to have poor control despite insulin treatment. Repeated episodes of severe hypoglycaemia increase healthcare costs and can have serious health consequences.    

Methods: We developed two care pathways, describing a structured approach for patients on insulin (High HbA1c Pathway) and for patients with concerning hypoglycaemia (Problematic Hypoglycaemia Pathway). Intensive nurse support clinics, an app for remote monitoring and a weekly Diabetes MDT meeting were introduced. One year after introduction the outcomes were reviewed. 

Results: On the high HbA1c pathway mean HbA1c reduction on the first cohort was by 22.4 mmol/mol for the 25 patients (57%) with repeat values available, which compares favourably to a historic cohort from 2019, receiving standard care, with mean HbA1c reduction of 1.4 mmol/mol. On average 11.6 patient contacts per patient with the diabetes team over a year were noted, which represents a significant increase compared to historic data of 1.8 contacts over 6 months. The number of patient contacts for each patient did not statistically correlate with their HbA1c change.  

All patients in the Hypoglycaemia Pathway had type 1 diabetes with a mean HbA1c of 60 mmol/mol. On review, concerning hypoglycaemia had resolved in 9 (50%) patients, 14 (78%) patients were using intermittent glucose monitoring sensors, 1 RTCGM and 6 were established on an insulin pump. 

Conclusions: A proactive approach in identifying and managing patients with diabetes at risk results in meaningful clinical outcomes with HbA1c improvements and reduction in concerning hypoglycaemia.