Over three million people have diabetes in the UK, 90 per cent of whom have the type 2 form of the condition. The care pathway for these patients is complex, largely due to a divide between primary and secondary care. Because of the need for concomitant treatment of cardiovascular and other diabetes-related risk factors, patients are also often prescribed multiple medications – a phenomenon known as treatment complexity. Adding to this is the large number of drugs available for the condition itself. Yet, despite the wide choice of therapies, clinical inertia, that is, failure to start or escalate treatment in people with poor diabetes control, is common. Together, clinical inertia and care pathway and treatment complexity impact the quality of diabetes services, contributing to poor patient outcomes and experience, avoidable hospital admissions, and wastage.

Integrated care

“There is the need for an integrated care model that by promoting collaboration between GPs and specialists reduces complexity,” says Dr Partha Kar, clinical director of diabetes at Portsmouth Hospitals NHS Trust, Hampshire. “Currently, the management of type 2 diabetes is fragmented and incredibly variable across the UK. Specialists, who provide most of the follow-up care, significantly impacting costs, need to collaborate with GPs, so that patients are discharged back into primary care, when appropriate”

Dr Kar and his specialist team have pioneered the multi-award-winning Super Six model, which aims to integrate diabetes management across primary and secondary care. Since implementation, in 2011, hospital admissions due hypoglycaemia (low blood glucose) and diabetic ketoacidosis (high blood glucose) have dropped by about 38 and 28 per cent, respectively. And diabetes-related foot amputations have gone from 2.3 to 1.3 per year.

The future

“Collaboration is incredibly important and it’s happening more and more in the NHS, paving the way for improved and more efficient care for people with diabetes,” says Dr Kar. “Keys to success are increased use of information technology for data communication and sharing, pooling budgets for primary and secondary care, and empowering patients in the management of their condition, through education as well as involvement in care planning and decision making.”