Sue Marshall blogs about diabetes for Desang


Following the hoop-la that went on recently about judging ‘lifestyle losers’, diabetes experts have added to the commentary by saying proposals put forward by the group Reform were fundamentally flawed and would cause unnecessary alarm to the country’s growing number of people with diabetes.

DOCTORS specialising in the treatment of diabetes today hit out at a think tank’s call for a reduction in hospital beds nationwide, saying it put cash savings before patient care.

The Association of British Clinical Diabetologists (ABCD) said that the proposals put forward by the group Reform were fundamentally flawed and would cause unnecessary alarm to the country’s growing number of people with diabetes.

Part of the rationale for Reform’s controversial proposals is that many services which are currently provided by hospitals will be able to be provided in the community – and diabetes was identified as one of these.

ABCD, which represents more than 500 specialist diabetes physicians nationwide, said this idea demonstrated a fundamental lack of understanding of diabetes and its management.

Its Honorary Secretary, Dr Ian Gallen, a consultant physician and endocrinologist at Buckinghamshire Hospitals NHS Trust, said: “We do not believe that the care of critically ill emergency patients and those with diabetes coincident with other conditions requiring hospitalisation, can be provided in the community. Any suggestion of cutting hospital beds on these grounds is foolish.

“The hospital specialist diabetes team can provide effective support to improve the quality of inpatient diabetes care, reduce length of stay and diabetes-related morbidity, as well as serving an important role in avoidance of admission in some cases.

“ABCD is concerned that the changes in the care for people with diabetes is being suggested as a driver for reduction in hospital beds. Reform has provided no data to support these changes, and such proposals will alarm people with diabetes with the prospect that they will in the future be unable to access necessary emergency care.”

People with diabetes are only in the hospital as a result of either emergencies related to diabetes such as diabetic keto-acidosis, or limb-threatening complications of diabetes, or because diabetes is complicating other acute medical conditions including myocardial infarction, stroke, and infectious respiratory disease.

However, diabetes is an endemic condition in the UK affecting perhaps 5% of the adult population.

The recent national diabetes inpatient audit found that up to 20%  of medical and surgical beds are occupied by people with diabetes. There is abundant evidence that the diabetes care they receive is variable without the support of an inpatient specialist diabetes team.

Published research has demonstrated the improved quality of care and reduced length of stay through such input. In addition, data from the National Diabetes Information service shows that without inpatient specialist support, co-morbid diabetes increases the time patients with chest disease and those undergoing surgery need to stay in hospital as well as increasing their likelihood of readmission following discharge.

People with diabetes also receive outpatient care in hospitals. The types of patients who should receive specialist care is outlined in the National Service Framework (NSF) for diabetes, and would typically be for patients with the complications of diabetes such as kidney failure or foot ulceration, for children and young adults, and women with pregnancy complicated by diabetes, and for people with complex treatment for diabetes including insulin pump therapy.

Dr Gallen added: “All primary health care trusts are working with their diabetes networks to ensure that people with diabetes are seen by the most appropriate staff, in the most appropriate setting, and this report adds nothing to this process.”


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