How King's Health Partners is improving outcomes for people with diabetes
Why diabetes matters
Diabetes affects more people than all cancers and dementia combined. At any given time, one in six people in a hospital bed in the UK has diabetes. With the number of people with diabetes in the UK doubling in the last 20 years, the number of people experiencing complications or dying because of diabetes is growing too. Yet only 17% of people in the UK think diabetes is a serious condition (compared to 85% for cancer and 69% for dementia).
One in 15 people in the UK has diabetes; that's 4.7 million people. By 2030, it is predicted the number of people with diabetes will have increased to 5.5 million.
Around 40% of people with diabetes also find it affects their psychological wellbeing and 64% of people with diabetes sometimes or often feel down about having diabetes. People with diabetes are twice as likely to suffer from depression than people without diabetes, and depression is also more likely to last longer and be more frequent for those with diabetes.
Our role as healthcare providers and researchers has therefore never been more important in helping prevent type 2 diabetes and in ensuring the people who already have diabetes get the support they need to safely manage their condition.
I have a big interest in type 1 diabetes. This type of diabetes is a forgotten tribe as it were as quite rightly there is a lot of attention on type 2 diabetes and obesity. It’s a very different condition because there’s no other medication where a person has to think of, adjust and adapt it multiple times per day without having any medical support to do that in between their appointments, and where a slight misjudgement could be unpleasant, or in rare cases catastrophic in the way it works.
It is a relentless condition where the treating team really need to come together in much the same way as the principles of King’s Health Partners – education, mind and body approach - these factors are brought together to support the patient, and these principles drive the team here at King’s College Hospital to do the best we can to help our patients.
- Dr Pratik Choudhary, Senior Lecturer and Consultant in Diabetes, King's College Hospital NHS Foundation Trust.
Diabetes is 90% self-management and requires so much from the patient. A person with diabetes must do so many different things and that can feel like a burden, and therefore we need to continue finding novel psychological approaches to help people feel confident about looking after their diabetes.
- Prof Khalida Ismail, Professor of Diabetes, King's College London.
How the Institute of Diabetes, Endocrinology & Obesity is making a difference
Collectively, the Institute is the largest provider of diabetes and endocrinology services in the UK, serving a large, culturally diverse population of around two million patients across a wide reaching geographical area spanning greater London and the South East.
With around 3.8 million people diagnosed with diabetes, an estimated one million living with undiagnosed diabetes, and nearly two-thirds of the adult population overweight or obese, efforts to better prevent, diagnose and care for diabetes and obesity are more important than ever.
We have a hugely exciting opportunity afforded through King’s Health Partners to build on our collective strengths to keep improving the health outcomes of our local populations, speed up the translation of research and innovation into clinical practice, and to provide world-class education and training.
- Kate Lillywhite, Programme Director, Institute of Diabetes, Endocrinology & Obesity
The role of the Institute is vital in ensuring our local population has equitable access to the best healthcare that provides the outcomes that matter to them.
The top five areas of focus are:
- One team approach - delivering more effective, integrated care across King’s Health Partners organisations, leading to a more efficient clinical pathways and better outcomes for patients
- Research and innovation – working across our organisations to offer patients and service users the very best care, based on reliable research evidence that works
- A Mind & Body approach - ensuring coordinated 'whole person' approach across physical and mental health to improve the care our patients receive
- Education - developing diabetes and obesity education programmes for healthcare professionals and service users that draws from the expertise of our world-class clinical and research teams across King’s Health Partners
- Systemwide leadership and insight - ensuring we have coordinated leadership across our local and national initiatives to enable collaboration across primary, community and secondary care to support diabetes and obesity prevention and treatment.
A closer look at diabetes and mental health
The Institute of Diabetes, Endocrinology & Obesity is supporting the development of diabetes healthcare systems that address the mental and physical impact of diabetes and enable staff to feel confident in discussing mental health with their patients. Providing integrated mental health support to people with diabetes can improve health outcomes by helping people to self-manage their diabetes, reducing hospital admissions and giving people a better quality of life.
The Institute continues to work closely with colleagues from our Mind & Body Team to expand the use of our mental health screening tool IMPARTS across services, supported by changes to clinical pathways to accommodate the emotional and psychological needs of our patients.
We are now six months into delivery of an integrated care pilot for Type 1 Diabetes and Disordered Eating (T1DE) (also known as Diabulimia). T1DE brings together a multidisciplinary 'hub' network of healthcare professionals across our partner organisations who work closely to provide patient-led treatment plans that address mental and physical health needs of patients. The ‘hub’ also offers support to spoke sites (across all five of the London Sustainability and Transformation Partnerships (STPs)) who refer people into the service for assessment.
Case study: How our Multi-Disciplinary Foot Care Team is helping patients
In the UK, people with diabetes are 20 times more likely to have an amputation and there are more than 8,500 leg, toe or foot amputations every year due to diabetes. The Diabetic Foot Clinic at King’s College Hospital was established in 1981 to help reduce the number of amputations and offer medical support to people with diabetes.
The Diabetic Foot Clinic at King’s College Hospital has a very low major amputation rate; patients with severe foot ulcers registered with the National Diabetic Foot Audit (2015-18) was 1.4% at King’s compared to 2.7% nationally. Two patients who have been receiving treatment at the Diabetic Foot Clinic over the past year speak about their experience.
The first patient explained:
The team here work under incredible pressure, I saw it in spades because I was at the clinic so often and I always had great treatment. I could not have had better support.
When I’ve come here, they’ve always told me what to do and they’ve saved me from losing my toe.
I am also much more conscious of my condition now which is a good thing.
The second patient stated:
The team here have been extremely supportive. They listened to what I had to say about my foot and gave me the treatment I needed, and were thorough in making sure the problem was resolved.
The Clinic has helped these patients and many others to avoid life-changing surgery and continues to support patients across south London and beyond.
Learn more and get involved
The Institute of Diabetes, Endocrinology & Obesity constantly strives to enhance existing partnerships and build new ones with patients, carers and families, clinical and academic staff, industry partners, and others working across the wider system.
If you have a project or idea related to diabetes, endocrinology or obesity we can provide support in the following areas:
- Project management
- Data and analytics
- Raising awareness of your project or idea
- Helping to build links with clinicians and academics and industry partners
- Events management.
To find out more, please get in touch with us.
Kate Lillywhite, Programme Director kate.lillywhiteATnhs.net
Phil Freeman, Programme Implementation Lead phil.freemanATkcl.ac.uk
Post Graduate Programme in Diabetes and Obesity
An internationally recognised multi-disciplinary online programme will be launched in Autumn 2020, spanning mental and physical health in Diabetes, Endocrinology and Obesity, developed by leading clinical academics in these fields.
This programme will be suitable for a wide range of healthcare professionals, nationally and internationally, and aims to support development of skills in these areas. More detailed information will be available in late Summer 2020.
King’s Health Partners Learning Hub offers free courses to help staff work with patients to prevent and manage diabetes. Some examples include:
Addressing Obesity in a Consultation shows how to broach the topic sensitively and effectively with patients and devise a patient-centred action plan to prevent diabetes developing.
Fight the Fads is an excellent source of information that can be used to inform your own eating choices or to support patients and service users who are interested in improving their diet.
Metabolism covers the four key pathways, explaining each one’s importance and going step-by-step through the reactions involved and how they are regulated. Each lecture lasts about 45 minutes and is supported by self-check questions and links to additional online resources.
Lastly, the ThinkGlucose toolkit developed by Guy’s and St Thomas’ NHS Foundation Trust helps ward staff manage patients’ blood glucose and act appropriately. The module includes a short video introducing the toolkit and demonstrating how to use the blood glucose monitoring chart and guidelines, followed by a guided tutorial to practice using the toolkit.
All statistics are taken from the ‘Us, diabetes and a lot of facts and stats’ report from Diabetes UK
We are bringing together clinical, research and educational expertise in diabetes from across our partnership with our world-class Institute of Diabetes, Obesity and Endocrinology.